Morbidity and mortality of crystalloids compared to colloids in critically ill surgical patients a subgroup analysis of a randomized trial

Abstract

Background: Te multicenter randomized Colloids versus Crystalloids for the Resuscitation of the Critically Ill (CRISTAL) trial was designed to test whether colloids altered mortality compared to crystalloids in the resuscitation of intensive care unit patients with hypovolemic shock. Tis preplanned analysis tested the same hypothesis in the subgroup of surgical patients. Methods: Te CRISTAL trial prospectively defned patients as critically ill surgical patients whenever they underwent emergency or scheduled surgery immediately before or within 24h of intensive care unit admission and had hypovolemic shock. Te primary outcome measure was death by day 28. Secondary outcome measures included death by day 90, the need for renal replacement therapy, or the need for fresh frozen plasma transfusion. Results: Tere were 741 critically ill surgical patients, 356 and 385 in the crystalloid and colloid arm, respectively. Median (interquartile range) age was 66 (52 to 76) yr, and 484 (65.3%) patients were male. Surgery was unscheduled in 543 (73.3%) cases. Mortality by day 28 did not signifcantly differ for crystalloids 84 (23.6%) versus colloids 100 (26%; adjusted odds ratio, 0.86; 95% CI, 0.61 to 1.21; P = 0.768). Death by day 90 (111 [31.2%] vs. 122 [31.7%]; adjusted odds ratio, 0.97; 95% CI, 0.70 to 1.33; P = 0.919) did not signifcantly differ between groups. Renal replacement therapy was required for 42 (11.8%) patients in the crystalloids arm versus 49 (12.7%) in the colloids arm (P = 0.871). Conclusions: Te authors found no survival beneft when comparing crystalloids to colloids in critically ill surgical patients.