• Fernando G Zampieri and Otavio T Ranzani.
• 1Intensive Care Unit Department, Emergency Medicine Discipline, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.2Intensive Care Unit, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil.3Respiratory Intensive Care Unit Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.4Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil.5Post-graduation Program in Medical Sciences Department, Faculty of Medicine, University of Ceará, Ceará, Brazil.6Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.
• Crit. Care Med. 2016 Dec 1; 44 (12): 2163-2170.

ObjectivesTo assess the impact of the percentage of fluid infused as Lactated Ringer (%LR) during the first 2 days of ICU admission in hospital mortality and occurrence of acute kidney injury.DesignRetrospective cohort.SettingAnalysis of a large public database (Multiparameter Intelligent Monitoring in Intensive Care-II).PatientsAdult patients with at least 2 days of ICU stay, admission creatinine lower than 5 mg/dL, and that received at least 500 mL of fluid in the first 48 hours.InterventionsNone.Measurement And Main Results10,249 patients were included in mortality analysis and 8,085 were included in the acute kidney injury analysis. For acute kidney injury analysis, we excluded patients achieving acute kidney injury criteria in the first 2 days of ICU stay. Acute kidney injury was defined as stage 2/3 Kidney Disease: Improving Global Outcomes creatinine criteria and was assessed from days 3-7. The effects of %LR in both outcomes were assessed through logistic regression controlling for confounders. Principal component analysis was applied to assess the effect of volume of each fluid type on mortality. Higher %LR was associated with lower mortality and less acute kidney injury. %LR effect increased with total volume of fluid infused. For patients in the fourth quartile of fluid volume (> 7 L), the odds ratio for mortality for %LR equal to 75% versus %LR equal to 25% was 0.50 (95% CI, 0.32-0.79; p < 0.001). Principal component analysis suggested that volume of Lactated Ringer and 0.9% saline infused had opposite effects in outcome, favoring Lactated Ringer.ConclusionsHigher %LR was associated with reduced hospital mortality and with less acute kidney injury from days 3-7 after ICU admission. The association between %LR and mortality was influenced by the total volume of fluids infused.

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