Restrictive fluid vs. liberal fluid resuscitation among patients with sepsis, which is beneficial? Systematic review and meta-analysis

<ns3:p>Abstract* Introduction Sepsis, a dysregulated immune response to infection, is a leading cause of in-hospital mortality. While intravenous fluid resuscitation is the cornerstone of early therapy, the optimal volume and strategy are debated. This systematic review and meta-analysis aimed to synthesize the latest evidence comparing the efficacy and safety of restrictive versus liberal fluid resuscitation in adult sepsis patients. Methods Following the PRISMA Guideline 2020 (PROSPERO: CRD420251081057), a systematic review and meta-analysis of RCTs/CTs published between 2015-2024 was conducted. Databases, including PubMed, ScienceDirect, Epistemonikos, and Google Scholar, were searched using keywords such as “sepsis” AND “fluid restriction” AND “mortality.” Data extraction and risk of bias (RoB2) analysis were performed independently. Meta-analysis was performed using RevMan 5.4 with a random effects model for mortality and vasopressor-free days. Result Fourteen articles (4097 patients) were included. Mortality analyses at 7, 28, 30, and 90 days showed no statistically significant differences between restrictive and control fluid strategies, despite some individual trends. There was no discernible effect on the days alive without vasopressors (MD 0.53 days, I2 = 62%). The risk of bias varied, with five low-, seven medium-, and three high-risk studies. Publication bias suggests the possibility of small, unpublished studies. Conclusion This meta-analysis found no significant mortality difference between restrictive and liberal fluid resuscitation in adults with sepsis, nor a significant impact on vasopressor-free days. Restrictive strategies do not increase harm and may reduce complications such as mechanical ventilation. Future research needs consistent fluid definitions and patient stratification according to severity [e.g., Sequential Organ Failure Assessment Score (SOFA) scores] to clarify optimal fluid management in sepsis.</ns3:p>