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Association Between the Choice of IV Crystalloid and In-Hospital Mortality Among Critically Ill Adults With Sepsis

regression model. All statistical analyses were performed with STATA 10.1 software (Stata Corp, College Station, Tex). The final analysis included 138 admissions for 119 patients, with admission to the ICU and the step-down unit indicated for 40 and 98 episodes, respectively. Twenty-eight episodes (20%) were associated with a CO in 26 patients (CO group); 110 episodes (80%) were uncomplicated in 93 patients (uncomplicated outcome group; UCO group). The 2 groups were generally similar in baseline characteristics, including the severity of SCD. Hospital stays preceding ICU admission were mainly related to SCD, including vaso-occlusive pain crises in 88 episodes and ACS in 28 (64% and 20%, respectively). The CO group had higher respiratory rate and core temperature, lower hemoglobin values and platelet counts, and higher aspartate aminotransferase and creatinine levels in the 48 hours preceding ICU admission (all P < 0.05). Therapeutic management before ICU admission was similar in the 2 groups. The proportion of episodes where blood packs had been administered before the ICU stay did not differ between the CO and UCO groups (6/28 [21%] and 35/110 [32%], respectively; P = 0.3). Acute chest syndrome was the most frequent diagnosis on ICU admission (99; 72%), whereas it accounted for 20% of the initial diagnoses; 3 additional patients developed ACS during the ICU stay, for 102 episodes with a final diagnosis of ACS. An infection was documented in 29 episodes (21%), more often in the CO than in the UCO group. Mechanical ventilation was administered to 25 episodes (18%), including 21 with a diagnosis of ACS on ICU admission and 23 episodes with a final diagnosis of ACS. Vasoactive drugs were given in 10 episodes (7%). Acute kidney injury was diagnosed in 14 episodes (10%) on ICU admission; 10 of these required renal replacement therapy. Blood transfusionswere given in 115 episodes (83%) during the hospitalization and included 28 (100%) in the CO group and 86 episodes (79%) in the UCO group. Single transfusion, phlebotomy, or exchange transfusion was used in 86, 11, and 47 episodes, respectively. The CO group received 5 packs of red blood cells compared with 2 for the UCO group (P < 0.001). The overall median ICU stay was 4 days; it was 9 days in the CO group compared with 3 days in the UCO group (P < 0.001). Nine patients died in the ICU, all of SCD-related causes. No deaths occurred after ICU discharge. A hemoglobin value of 7.8 g/dL or less (odds ratio [OR] 3.6; 95% confidence interval [CI], 1.1–11.9), a respiratory rate of 32 cycles/min or greater (OR, 5.6; 95% CI, 1.8–17.2), and acute kidney injury on ICU admission (OR, 11.5; 95% CI, 2.5–52.6) were independently associated with CO. Patients with SCD have a high risk of complications when they are admitted to an ICU, even those with preexisting mildto-moderate SCD. Caregivers should be aware of the signs of aggressiveness of acute disease, which include a deep and sustained drop in hemoglobin associated with other disorders involving the lungs and kidneys, despite adequate management during the pre-ICU hospitalization. These markers require careful consideration in the decision to transfer patients to the ICU early in the hospital stay.