Why physiology will continue to guide the choice between balanced crystalloids and normal saline: a systematic review and meta-analysis

Table 2 Comparison of meta-analyses. Results from meta-analyses before and after the two recent landmark trials on saline versus balanced crystalloids in the setting of intensive care medicine and emergency medicine. For reference, information from two large ongoing trials on this topic has also been included

	Meta-analyses							Current meta-analysis				Landmark trials		Ongoing trials
First author, year	Serpa, 2017 [29]	Kawano, 2018 [13]	Zayed, 2018 [14]	Liu, 2019 [18]	Xue, 2019 [17]	Xue, 2019 [17]	Xue, 2019 [17]	Zwager	Zwager	Zwager	Zwager	Semler, 2018 [15]	Self, 2018 [16]	BASICS	PLUS
Setting or type of sensitivity analysis	ICU	ICU/OR	ICU	ICU	ICU	Sepsis	TBI	ICU	ED	Sepsis	TBI	ICU	ED	ICU	ICU
n	2348	3710	2269	20345	19301	2420	1420	6350	1457	1873	1219	15802	13347	11000	8800
Analysis
Adjusted for design effect?	No	No	No	No	No	No	No	Yes	Yes	Yes	Yes	–	–	–	–
Mortality (balanced crystalloids, %)	7.54	8.91	11.50	10.33	10.12	24.83	15.21	11.37	1.65	33.05	15.21	11.68	1.40
Mortality (normal saline, %)	8.57	9.61	12.20	13.17	10.93	28.96	13.77	12.10	2.06	37.95	14.14	12.40	1.54
Risk ratio	0.88	0.90	0.94	0.93	0.92	0.86	1.11	0.94	0.83	0.87	1.08	0.94	0.90
P value for risk ratio	0.36	0.44	0.10	0.08	0.06	0.02	0.43	0.36	0.62	0.02	0.58	0.10	0.43
RRR (%)	0.12	0.10	0.06	0.07	0.08	0.14	− 0.11	0.06	0.17	0.13	− 0.08	0.06	0.10
Assumed baseline mortality (%)		30.00		13.20	10.93	29.00		12.10	2.06	37.95	14.14			35.00	23.00
Assumed RRR (%)		10.00		10.00	6.42	14.48		5.00	5.00	5.00	5.00			10.00	12.50
Alpha (%)		5		5	5	5		5	5	5	5			5	5
Power (%)		80		90	90	90		90	90	90	90			89	90
Required information size (RIS)		9517		26456	80946	4686		117514	827817	27139	99090			11000	8800
Accrued information size (AIS)		3710		20345	19301	2420		6350	1457	1873	1219
AIS/RIS		0.39		0.77	0.24	0.52		0.05	0.002	0.07	0.01

RRR relative risk reduction, RIS required information size, AIS accrued information size

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