{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T15:14:55Z","timestamp":1781277295973,"version":"3.54.1"},"reference-count":40,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2024,11,1]]},"abstract":"<jats:sec id=\"ab-ioi240057-4\"><jats:title>Importance<\/jats:title><jats:p>Sickle cell disease (SCD), a clinically heterogenous genetic hemoglobinopathy, is characterized by painful vaso-occlusive episodes (VOEs) that can require hospitalization. Patients admitted with VOEs are often initially resuscitated with normal saline (NS) to improve concurrent hypovolemia, despite preclinical evidence that NS may promote erythrocyte sickling. The comparative effectiveness of alternative volume-expanding fluids (eg, lactated Ringer [LR]) for resuscitation during VOEs is unclear.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi240057-5\"><jats:title>Objective<\/jats:title><jats:p>To compare the effectiveness of LR to NS fluid resuscitation in patients with SCD and VOEs.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi240057-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This multicenter cohort study and target trial emulation included inpatient adults with SCD VOEs who received either LR or NS on hospital day 1. The Premier PINC AI database (2016-2022), a multicenter clinical database including approximately 25% of US hospitalizations was used. The analysis took place between October 6, 2023, and June 20, 2024.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi240057-7\"><jats:title>Exposure<\/jats:title><jats:p>Receipt of LR (intervention) or NS (control) on hospital day 1.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi240057-8\"><jats:title>Main Outcome and Measures<\/jats:title><jats:p>The primary outcome was hospital-free days (HFDs) by day 30. Targeted maximum likelihood estimation was used to calculate marginal effect estimates. Heterogeneity of treatment effect was explored in subgroups.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi240057-9\"><jats:title>Results<\/jats:title><jats:p>A total of 55\u202f574 patient encounters where LR (n\u2009=\u20093495) or NS (n\u2009=\u200952\u202f079) was administered on hospital day 1 were included; the median (IQR) age was 30 (25-37) years. Patients who received LR had more HFDs compared with those who received NS (marginal mean difference, 0.4; 95% CI, 0.1-0.6 days). Patients who received LR also had shorter hospital lengths of stay (marginal mean difference, \u22120.4; 95% CI, \u22120.7 to \u22120.1 days) and lower risk of 30-day readmission (marginal risk difference, \u22125.8%; 95% CI, \u22129.8% to \u22121.8%). Differences in HFDs between LR and NS were heterogenous based on fluid volume received: among patients who received less than 2 L, there was no difference in LR vs NS; among those who received 2 or more L, LR was superior to NS.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi240057-10\"><jats:title>Conclusion and Relevance<\/jats:title><jats:p>This cohort study found that, compared with NS, LR had a small but significant improvement in HFDs and secondary outcomes including 30-day readmission. These results suggest that, among patients with VOEs in whom clinicians plan to give volume resuscitation fluids on hospital admission, LR should be preferred over NS.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamainternmed.2024.4428","type":"journal-article","created":{"date-parts":[[2024,9,9]],"date-time":"2024-09-09T15:01:16Z","timestamp":1725894076000},"page":"1365","source":"Crossref","is-referenced-by-count":4,"title":["Lactated Ringer vs Normal Saline Solution During Sickle Cell Vaso-Occlusive Episodes"],"prefix":"10.1001","volume":"184","author":[{"given":"Augusta K.","family":"Alwang","sequence":"first","affiliation":[{"name":"Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anica C.","family":"Law","sequence":"additional","affiliation":[{"name":"The Pulmonary Center, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, 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