Importance: 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.
Objective: To compare the effectiveness of LR to NS fluid resuscitation in patients with SCD and VOEs.
Design, setting, and participants: 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.
Exposure: Receipt of LR (intervention) or NS (control) on hospital day 1.
Main outcome and measures: 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.
Results: A total of 55 574 patient encounters where LR (n = 3495) or NS (n = 52 079) 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, -0.4; 95% CI, -0.7 to -0.1 days) and lower risk of 30-day readmission (marginal risk difference, -5.8%; 95% CI, -9.8% to -1.8%). 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.
Conclusion and relevance: 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.
Carbons with Brønsted acidic sites and iron oxide modifications were prepared through hydrothermal carbonization and glycerol pyrolysis in the presence of sulfuric acid, magnetite, and iron(III) nitrate. The solids were tested as catalysts in converting fructose to 5-hydroxymethylfurfural (5-HMF). Characterization techniques revealed a uniform presence of 4.89 mmol g-1 total acidic groups, including up to 1.87 mmol g-1 sulfonic and carboxylic groups. Combined with a reduced surface area, the Brønsted and Lewis acidity enabled the conversion of 94% of fructose with selectivity values as high as 95% for 5-HMF in just 10 min at 140 °C, using microwave heating and dimethyl sulfoxide (DMSO) as the solvent. This performance was attributed to the selective heating of the catalyst surface by the microwave absorption capacity of the acidic groups and iron oxide, leading to the formation of "hot spots." The catalyst obtained by hydrothermal carbonization in the presence of Fe3O4, HCC-20% Fe3O4, demonstrated stability when reused for up to four consecutive cycles. A slight reduction in conversion and selectivity was observed after the first use, attributed to the presence of acid species not incorporated into the solid during the synthesis process.
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