P-2198. Effect of IV Fluids on Diuretic Need in Pediatric and Adult Dengue Patients: A Network Meta Analysis and Systematic Review

TL;DR

This study compares different IV fluids used in dengue patients to see if they affect the need for diuretics like furosemide, finding no strong evidence of differences.

Contribution

The study provides a network meta-analysis comparing IV fluids in dengue patients, focusing on diuretic use.

Findings

No significant association was found between IV fluid type and furosemide use in dengue patients.

Dextran vs Gelatin showed a non-significant trend favoring Dextran.

Heterogeneity was low overall, except for Dextran vs Ringer’s Lactate comparisons.

Abstract

Dengue fever (DF), transmitted by Aedes aegypti and Aedes albopictus, mostly in tropical and subtropical regions, causes high fever, muscle cramps, and joint pain. Fluid resuscitation is the mainstay of treatment, with Ringer’s Lactate (RL) being the first line recommended by the World Health Organization (WHO). Capillary leakage during resuscitation may happen and require diuretics, so the best IV fluid option for managing dengue remains in discussion.Figure 1:Network plorNetwork plot comparing the IV fluids and number of studiesFigure 2:Forest Plot

Network plor

Network plot comparing the IV fluids and number of studies

Forest Plot

Forest plot with indirect and direct effects on studies comparing IV fluids and the use of furosemide

A literature search was performed in PubMed, Embase, and the Cochrane Library databases for Randomized Controlled Trials (RCTs) comparing RL with alternative IV fluids in patients with DF. The primary outcome was the use of furosemide after IV infusion. Data were analyzed using R, with heterogeneity assessed. Reference management and deduplication were done via PROSPERO, and risk of bias was evaluated using ROB-2.

Five RCTs were included, and direct/indirect comparisons were made (Figure 1). In this network meta-analysis of fluid therapies, Dextran vs Gelatin showed a non-significant trend favoring Dextran (Direct OR: 0.51; 95% CI: [0.10, 2.54]; Network OR: 0.78; [0.18, 3.34]). Dextran vs Ringer’s Lactate showed no clear difference (Direct and Network OR: 0.88), though the indirect estimate was highly imprecise. Dextran vs Saline also showed no meaningful difference (Network OR: 0.99; [0.22, 4.35]). Gelatin vs Ringer’s Lactate and Saline vs Ringer’s Lactate both showed no significant differences (Network ORs: 1.13 and 0.89, respectively), with wide confidence intervals. Heterogeneity was generally low (I² = 0%), except for Dextran vs Ringer’s Lactate (I² = 62.4%), indicating moderate inconsistency in that comparison (Figure 2).

There was no significant association between the type of IV fluid administered and the need for furosemide due to plasma leakage. Further robust, direct comparisons are needed to strengthen the current evidence base

All Authors: No reported disclosures

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