Life's essential 8 and risk of all-cause mortality in individuals with cardiovascular diseases: A prospective community-based study.

BACKGROUND: Although risk factors for mortality in individuals with cardiovascular diseases (CVD) have been reported, little is known regarding the association between the comprehensive cardiovascular health (CVH) index assessed by life's essential 8 (LE8) and the risk of mortality. HYPOTHESIS: The aim of this study was to evaluate the CVH assessed by LE8 and risk of mortality in individuals with CVD. METHODS: A total of 1391 participants with CVD diagnosed before 2014 from the Kailuan cohort were included in the analysis. The CVH score ranged from 0 to 100 was assessed using the LE8 metrics (diet quality, physical activity, sleep health, cigarette smoking, body mass index, lipids, blood glucose, and blood pressure). Cox regression model was used to estimate the association between the CVH score and risk of all-cause mortality. RESULTS: During a mean follow-up of 6.1 ± 1.5 years, 229 deaths occurred. The hazard ratio for all-cause mortality was 0.57 (95% confidence interval [CI]: 0.38, 0.84) in the highest quartiles compared with the lowest quartiles of CVH scores and 0.85 (95% CI: 0.75, 0.95) for each 10 points increment in CVH scores (ptrend = .009), after adjustment for age, sex, CVD duration, social-economic status, alcohol consumption, inflammation, medicine use, and kidney function. We did not observe significant interactions between the CVH scores and age, sex, and duration of CVD diagnosis (pinteraction > .05 for all). CONCLUSIONS: The CVH assessed by the LE8 metrics was associated with a lower risk of all-cause mortality in individuals with CVD.

Better Life's Essential 8 Is Associated With Lower Risk of Diabetic Kidney Disease: A Community-Based Study.

Background Diabetic kidney disease (DKD) is a common diabetic complication and increases the complexity of diabetes management. No prospective study has focused on the association between DKD and Life's Essential 8 (LE8). Our study aims to examine the association between LE8 and DKD risk. Methods and Results A total of 7605 participants, aged 54.32±9.77 years, and 4688 participants, aged 56.11±10.38 years, were included in the longitudinal and trajectory analyses, respectively, from 2006 to 2020. The DKD was confirmed using data collected during each follow-up. LE8 was based on 4 health behaviors and 4 health factors. The range of each metric was 0 to 100, and the overall LE8 score was calculated as the unweighted average of all 8 component metric scores. The trajectories of LE8 during 2006 to 2010 were classified using latent mixture models. Cox models and restricted cubic splines were applied. After a median follow-up of 12.41 and 6.71 years in longitudinal and trajectory analyses, respectively, the DKD incidence decreased, with the LE8 level increasing (P-trend<0.05), and the linearity assumption for this relationship (P-nonlinear=0.685) had been satisfied. Adjusted hazard ratios (HRs) for the highest tertile were 0.77 (95% CI, 0.69-0.87) and 0.70 (95% CI, 0.62-0.78) in baseline and time-updated LE8 scores, respectively, compared with the lowest tertile. Adjusted HR was 0.53 (95% CI, 0.41-0.69) for the stable-high pattern compared with the stable-low pattern. Conclusions Although LE8 is an indicator of cardiovascular health, the beneficial impact of a high LE8 score is also evident in the protection of renal health among patients with diabetes.

Life's Essential 8 and Risk of Stroke: A Prospective Community-Based Study.

BACKGROUND: Data are lacking regarding cardiovascular health (CVH) with Life's Essential 8 approach and future stroke risk. We sought to elucidate whether the CVH score constructed by the Life's Essential 8 metrics predicted stroke risk in 2 Chinese ongoing cohorts. METHODS: This included 41 043 participants of the Kailuan I study and 27 842 participants of the Kailuan II study who were free of cardiovascular disease or cancer in 2014. CVH score (ranged from 0 to 100) was assessed using the Life's Essential 8 metrics (body mass index, cigarette smoking, diet quality, physical activity, sleep health, lipid, blood glucose, and blood pressure). A composite of incident stroke events (ischemic stroke and hemorrhagic stroke) was identified via review of medical records. The follow-up period was calculated from the finishing date of the 2014 survey to either the date of stroke occurrence, death, loss to follow-up, or the end of follow-up (December 31, 2020). We also examined the longitudinal association between the CVH score and arterial stiffness status, as assessed by brachial-ankle pulse wave velocity, in 25 922 participants free of cardiovascular disease during the follow-up. We performed a meta-analysis to assess the association between CVH, based on the 2010 American Heart Association recommendation, and stroke integrating the results of current study and previous studies. RESULTS: During a median follow-up of 5.65 years (interquartile range, 5.20-6.09), a total of 1750 incident stroke events were identified in the pooled Kailuan study. The pooled hazard ratios were 0.33 (95% CI, 0.20-0.54) for ideal versus poor health category of CVH (Ptrend<0.0001). Higher CVH scores were also associated with lower brachial-ankle pulse wave velocity values at baseline and slower increments of brachial-ankle pulse wave velocity during follow-up (Ptrend≤0.001 for both). Arterial stiffness mediated 9.07% (95% CI, 5.83%-15.0%) of the total association between CVH and incident stroke. The pooled hazard ratio comparing 2 extreme CVH categories for stroke was 0.45 (95% CI, 0.35-0.59) when including 10 published studies and the current study. CONCLUSIONS: The CVH score as assessed by the Life's Essential 8 metrics significantly predicted future stroke risk and arterial stiffness status.

Time spent in a better cardiovascular health and risk of cardiovascular diseases and mortality: a prospective cohort study.

BACKGROUND: The protective effect of a higher ideal cardiovascular health (CVH) score on cardiovascular diseases (CVDs) and mortality is well recognized. However, little is known regarding the length of favorable CVH status associated with CVDs and mortality. This study aimed to examined whether the duration of better (ideal or intermediate) CVH is associated with risk of developing CVDs and mortality. METHODS: This prospective cohort study used data from 83,536 individuals from 2006 to 2020 who were enrolled in the Kailuan Study. The CVH scores of individuals were assessed at visits 1, 2, 3, and 4, respectively. The years spent in better CVH were estimated for each individual as the number of examination cycles (0-4) in which the participant was in that CVH score ≥ 8 multiplied by 2 (the mean year interval of each visit). The primary outcomes are CVD events and all-cause mortality. RESULTS: After a median follow-up period of 7.48 years, 5486 (7.07%) cases of incident CVD events and 7669 (9.18%) deaths occurred. Compared with participants in " ≤ 4 years" group, those who maintained for > 4 years had less likely to develop adverse outcomes (CVD events: hazard ratio (HR): 0.60, 95% confidence interval (CI 0.56-0.63; all-cause mortality: HR: 0.77, 95% CI 0.74-0.81). The number of years spent in better CVH was nonlinearly correlated with CVD events or mortality (all Ps for nonlinear < 0.05). The results indicated that maintaining more than 6 years in a better CVH status was associated with a decreased risk of CVD events or mortality. CONCLUSION: Our study indicates that individuals maintaining more than 6 years in better CVH could increase cardiometabolic benefits and a lower risk of all-cause mortality.

Associations of Traumatic Injury with Abnormal Glucose Metabolism: A Population-Based Prospective Cohort Study.

Purpose: Empirical data on the association between traumatic injury and abnormal glucose metabolism risk is limited. This study aimed to investigate the association between traumatic injury and abnormal glucose metabolism. Patients and Methods: This study included 153,162 participants in the Kailuan Study from 2006 to 2013. Participants with abnormal glucose metabolism at baseline were excluded. All participants were monitored every two years until December 31, 2019. During follow-up, 1915 subjects with a first traumatic injury (defined as a physical injury caused by an external force) were identified. For each subject with traumatic injury, one control subject was randomly selected and matched for age (± 3 years) and sex. A total of 3830 subjects were included in the final analysis. Cox proportional hazards models were used to examine the association between traumatic injury and the subsequent risk of abnormal glucose metabolism. Results: During a median follow-up of 6.91 (3.57-9.41) years, 990 abnormal glucose metabolism events occurred. After adjustment for demographics, lifestyle behaviors, and traditional risk factors, those who had traumatic injury compared to controls were 32% more likely to develop any abnormal glucose metabolism (hazard ratio [HR] 1.32; 95% confidence interval [CI]1.16-1.49), including impaired fasting glucose (IFG) (HR 1.29; 95% CI 1.12-1.48) and diabetes (HR 1.37; 95% CI 1.10-1.70). The risks for abnormal glucose metabolism, IFG, and diabetes in subjects with moderate-severe injury were higher than in subjects with mild injury for the 1-year follow-up period, while the association was not significantly different by injury severity for the whole follow-up period. Conclusion: Traumatic injury was associated with an increased risk of abnormal glucose metabolism. However, the risks of outcome events decreased as the follow-up period extended. Improved short- and long-term prevention and management strategies for controlling glucose are needed for individuals with traumatic injury.

Association between exposure to earthquake in early life and diabetes mellitus incidence in adulthood with the modification of lifestyles: Results from the Kailuan study.

Background: Exposure to disasters in early life may induce lifetime health risk, but investigation on earthquake exposure and DM in later life is still limited. The aim of the current study is to evaluate the association between exposure to the Tangshan Earthquake in early life and diabetes mellitus (DM) incidence in adulthood, and explore the modification of lifestyles on DM development. Methods: Participants who were free of DM at baseline from the Kailuan Study were included in this study. All participants were divided into fetal-exposed, infant-exposed, early childhood-exposed and nonexposed group. The effect of earthquake exposure on DM and modification of lifestyles were examined by multivariable-adjusted Cox proportional hazard model. Results: The exposed group had a higher risk of DM than nonexposed group, especially in infant-exposed and early childhood-exposed group, with hazard ratio (HR) of 1.62 [95% confidence intervals (CI), 1.21-2.17] and 1.46 (95% CI, 1.06-1.99), respectively. After stratifying by lifestyles, a significant modification was observed in alcohol consumption. Conclusion: Exposing to earthquake in early life could increase DM incidence in later life, and alcohol consumption might modify the effect of earthquake exposure on DM development. More attention should be paid on the preventions of DM among adults who exposed to earthquake in their early life.

Serum Hs-CRP level and clinical significance of patients with stress ulcer caused by massive blood loss after trauma.

Stress ulcer refers to a specific type of irritation of the inner wall of the gastrointestinal tract that occurs rapidly due to acute physiological stress such as severe disease, infection, or trauma. This study investigated the serum Hs-CRP level and clinical significance of patients with stress ulcers caused by massive blood loss after trauma. For this purpose, we studied 113 patients with enormous blood loss after trauma. During the study, 26 patients developed stress ulcers. Therefore, patients with massive blood loss after trauma were divided into two groups with and without stress ulcers. In addition to clinical and demographical evaluations, serum Hs-CRP levels were measured by ELISA test method in all patients at baseline, 6, and 12 days after starting the study. Results showed that 24 patients were excluded from the study due to termination of cooperation or death. Finally, 89 patients participated in the final analysis. Of these 89 patients, 26 developed stress ulcers. There was a significant difference between the two groups with stress and non-stress ulcers in terms of mean age (P=0.001) and gender (P=0.041). Also, there was a significant difference between the two groups regarding re-bleeding (P=0.012), the number of hospitalization days (P=0.001), and a decrease in hemoglobin (P=0.035). But there was no difference between the two groups regarding the need for re-surgery (P=0.276). The results of this study showed that increased serum hs-CRP levels are directly related to stress ulcers. Patients with higher serum Hs-CRP levels were more likely to develop stress ulcers than patients without stress ulcers during six days (P=0.04) and twelve days after starting the study (P=0.001). Current research results also show that the prevalence of stress ulcers occurs in men more than women. The risk of stress ulcers increases among older patients. People with stress ulcers also lose more hemoglobin, and finally, patients with more trauma and more extended hospital stays have a higher chance of developing stress ulcers.

Longitudinal Study of Brachial-Ankle Pulse Wave Velocity and Change in Estimated Glomerular Filtration Rate among Chinese Adults.

BACKGROUND AND OBJECTIVES: Studies on the association between arterial stiffness and kidney function have generated inconsistent results. Whether arterial stiffness is linked to decline in renal function warrants further study. This study aimed to investigate the association between brachial-ankle pulse wave velocity (baPWV) and longitudinal change in estimated glomerular filtration rate (eGFR) among Chinese adults. METHODS: In this longitudinal study, 8,264 participants in a community-based cohort had baPWV measured in 2010-2011 and were followed in subsequent surveys through to 2016. During each survey visit, fasting blood samples were collected for serum creatinine and eGFR was calculated. Participants were divided into 5 groups (Q1-Q5) by baPWV quintile. The association between baPWV and longitudinal changes in eGFR was assessed using generalized estimating equation models. RESULTS: A total of 8,045 participants were included in the final analysis. The average age was 54 ± 12 years (age range 24-97 years), and mean eGFR was 93.0 ± 18.6 mL/min/1.73 m2. There was an inverse linear association between baseline baPWV and eGFR change rate (p < 0.001). Compared with Q1 (lowest) group, the mean differences and 95% CI in eGFR decrease rate among Q2-Q5 groups were -0.23 (-0.62, 0.16), -0.67 (-1.06, -0.28), -1.11 (-1.50, -0.72), and -1.30 (-1.69, -0.92) mL/min/1.73 m2 per year, respectively, after adjustment for age, gender, and other potential confounders (p trend < 0.0001). For each 100 cm/s increase in baPWV at baseline, the fully adjusted mean difference in eGFR decrease rate was -0.14 mL/min/1.73 m2 per year (95% CI -0.18, -0.10; p < 0.0001). Compared with participants with baPWV < 1,400 cm/s, the fully adjusted mean difference in eGFR decrease rate was -0.92 mL/min/1.73 m2 per year (95% CI -1.18, -0.66) for those with baPWV ≥ 1,400 cm/s (p < 0.0001). CONCLUSIONS: Participants with a higher baPWV at baseline had a greater decrease in eGFR over time. Future studies could examine the relationship between baPWV and decline in renal function in higher risk cohorts, and its potential role in targeting reno-protective interventions to those who may benefit from them most.

The Cumulative Exposure to High-Sensitivity C-Reactive Protein Predicts the Risk of Chronic Kidney Diseases.

BACKGROUND AND OBJECTIVES: This study was to characterize the association of cumulative exposure to increased high-sensitivity C-reactive protein (hs-CRP) with chronic kidney diseases (CKD). METHODS: We included 35,194 participants with hs-CRP measured at three examinations in 2006, 2008, 2010. Participants were classified into nonexposed group (hs-CRP <3.0 mg/L in all 3 examinations), 1-exposed group (hs-CRP ≥3.0 mg/L in 1 of the 3 examinations), 2-exposed group (hs-CRP ≥3.0 mg/L in 2 of the 3 examinations), and 3-exposed group (hs-CRP ≥3.0 mg/L in 3 examinations). Cox proportional hazards models were used to assess the association of cumulative hs-CRP with incident CKD. CKD includes an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 or urinary protein positive. RESULTS: The study showed the risk of CKD as the number of years of exposure to hs-CRP increases. Participants in 3-exposed group had significantly increased CKD risk with hazard ratio (HR) (95% confidence interval, CI) of 1.70 (1.49-1.93), in comparison with 1.47 (1.34-1.62) for participants in the 2-exposed group, and 1.08 (1.00-1.16) for those in the 1-exposed group (p < 0.01); meanwhile, the similar and significant associations were also observed for eGFR <60 mL/min/1.73 m2, proteinuria positive, in participants of the 3-exposed group in comparison with the nonexposed group, with respective HRs (95% CI) of 1.27 (1.01-1.58) and 2.27 (1.87-2.76). CONCLUSIONS: Cumulative exposure to hs-CRP was associated with a subsequent increased risk of CKD and was of great value to risk prediction.

Cumulative Exposure to High-Sensitivity C-Reactive Protein Predicts the Risk of Cardiovascular Disease.

BACKGROUND: One measurement of hs-CRP (high-sensitivity C-reactive protein) is associated with increased risk of cardiovascular disease (CVD). The objective of this study was to characterize the association of cumulative exposure to increased hs-CRP with incident cardiovascular events. METHODS AND RESULTS: We included 53 065 participants with hs-CRP measured at 3 examinations in 2006, 2008, and 2010. Cumulative exposure to hs-CRP was calculated as the weighted sum of the average hs-CRP level for each time interval (level×time). Participants were classified into nonexposed group (hs-CRP<3.0 mg/L in all 3 examinations), 1-exposed group (hs-CRP≥3.0 mg/L in 1 of the 3 examinations), 2-exposed group (hs-CRP≥3.0 mg/L in 2 of the 3 examinations), and 3-exposed group (hs-CRP≥3.0 mg/L in 3 examinations). Cox proportional hazards models were used to assess the association of cumulative hs-CRP with incident CVD. The study showed a dose-response pattern with risk of CVD and myocardial infarction as the number of years of exposure to hs-CRP increases. Participants in the 3-exposed group had significantly increased CVD risk with hazard ratio (95% confidence interval) of 1.38 (1.11-1.72), in comparison with 1.28 (1.07-1.52) for participants in the 2-exposed group and 1.13 (0.97-1.31) for those in the 1-exposed group (P<0.05); meanwhile, the similar and significant associations were also observed for myocardial infarction with respective hazard ratio (95% confidence interval) of 2.13 (1.42-3.18), 1.60 (1.12-2.27), and 1.57 (1.17-2.10). The associations between stroke and cumulative hs-CRP were not statistically significant (P=0.360). CONCLUSIONS: Cumulative exposure to hs-CRP was dose dependently associated with a subsequent increased risk of CVD and myocardial infarction. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov/. Unique identifier: ChiCTR-TNC-11001489.

[Impact of systolic blood pressure on visit-to-visit blood pressure variability in middle-aged and elderly people].

OBJECTIVE: To observe the impact of systolic blood pressure (SBP) on visit-to-visit blood pressure variability (BPV) in middle-aged and elderly people. METHODS: Visit-to-visit BPV was determined in 5440 workers in the Kailuan study cohort from 2006 to 2007. The subjects were ≥ 40 years-old and had no history of stroke, transient ischemic attack or myocardial infarction. Participants were divided into five groups according to different levels of SBP. Linear regression was used to analyze the related factors which might affect BPV. RESULTS: Mean systolic BPV of all subjects was 10.35 mm Hg [coefficient of variation (CV 7.96%)]. The mean systolic BPV of males was 10.54 mm Hg (CV 7.90%) while the mean SBPV of females was 10.06 mm Hg (CV 7.90%). The BPV of males was significant higher than that of females (P < 0.001). CV of SBP was similar between males and females. Furthermore, higher SBP was associated with higher BPV. There were significant differences in BPV between different groups with different levels of SBP (P < 0.001). Linear regression analysis demonstrated that SBP, age, gender, high-sensitivity C-reactive protein (hsCRP) were affecting factors of BPV. Twenty mm Hg SBP increase was linked with 2.02 mm Hg BPV increase and 0.388%CV increase. Age increase of 1 year was associated with 0.044 mm Hg BPV increase and 0.029% CV increase. CONCLUSION: SBP, age, gender and hsCRP are important factors affecting BPV in middle-aged and elderly people. Higher SBP is closely related to greater BPV in this cohort.

[The effect of neuromuscular blocking agents on prognosis of patients with acute respiratory distress syndrome: a meta analysis].

OBJECTIVE: To determine the effects of neuromuscular blocking agent (NMBA) on prognosis of patients with acute respiratory distress syndrome (ARDS). METHODS: PubMed database, the Cochrane Library, EMBASE, Excepta Media, CBM, CNKI and other sources were used for retrieving the pertinent literature. All randomized controlled trials (RCTs) on NMBA treating ARDS patients were enrolled. The Cochrance Collaboration's software RevMan 5.0 was used for data analysis. Two authors independently extracted data and assessed study quality using standardized instruments. RESULTS: Three studies were included in the final analysis, providing a sample of 431 patients. The combined results demonstrated a decrease in 28 days mortality [Peto odds ratio (OR) =0.57, 95% confidence interval (95%CI) 0.37-0.88, P=0.01] and lower incidence of barotrauma (OR=0.42, 95%CI 0.20-0.91,P=0.003) after NMBA treatment for patients with ARDS as compared with control group. The incidence of acquired neuromyopathy was similar between NMBA group and control group (OR=1.20, 95%CI 0.67-2.14, P=0.54). As compared with the control group at 48 hours, there was no statistical difference in ventilator parameters including total positive end expiratory pressure (PEEP, OR=0.09, 95%CI -0.50-0.68, P=0.77) and plateau pressure (Pplat, OR=0.62, 95%CI -0.32-1.57, P=0.20). There was no heterogeneity (P>0.1, I (2)<50%). At 120 hours after NMBA treatment, the total PEEP was significantly lower than that of control group (OR=-1.22, 95%CI -2.39 to -0.04, P=0.04), and the difference in Pplat showed statistical difference compared with the control group (OR=-2.61, 95%CI -4.50 to -0.73, P=0.007). CONCLUSION: Early administration of NMBA for ARDS patients results in a significant reduction in 28 days mortality, and it improves outcome.

[The effect of an optimized resuscitation strategy on prognosis of patients with septic shock: a systematic review].

OBJECTIVE: To determine the treatment effect of an optimized resuscitation strategy on prognosis of patients with septic shock. METHODS: A systematic review of MEDLINE, the Cochrane Library, EMBASE, CBM, CNKI and other sources using a comprehensive strategy was conducted. All randomized controlled trials (RCTs) of treatment of severe sepsis and septic shock were included. The patients were randomized into treatment group and control group. Preplanned subgroup analysis required studies to be categorized based on early (goal-directed therapy accomplished within 6-24 hours) vs. late (initiated after 24 hours or unknown time of resuscitation implementation). Two authors independently extracted data and assessed study quality using standardized methods. Consensus was reached by conference. The Cochrance Collaboration's software RevMan 5.0 was used for data analysis. RESULTS: Eleven studies were included in the final analysis, providing a sample of 2066 patients. The combined results demonstrated a decrease in mortality [odds ratio (OR) = 0.63, 95% confidence interval (95%CI) 0.48-0.84, P = 0.002]; however, there was statistically significant heterogeneity [P = 0.01, I(2) = 55%]. Among the early optimal resuscitation studies (n = 8) there was minimal heterogeneity [P = 0.44, I(2) = 0%] and a significant decrease in mortality (OR = 0.53, 95%CI 0.42-0.66, P < 0.00001) and incidence of multiple organ dysfunction syndrome (MODS, OR = 0.61, 95%CI 0.43-0.85, P = 0.004). For the late resuscitation studies (n = 3), there was statistically significant difference [P = 0.05, I (2)=66%], and there was no significant effect on mortality (OR = 0.89, 95%CI 0.52-1.54, P = 0.68) and incidence of MODS (OR = 0.43, 95%CI 0.17-1.08, P = 0.07). CONCLUSION: This meta-analysis found that the application of an early optimal resuscitation strategy to patients with septic shock imparts a significant reduction in mortality and incidence of MODS.

[Influence of albumin as a resuscitation fluid on the prognosis of patients with sepsis: a Meta-analysis].

OBJECTIVE: To compare the effect of albumin as a resuscitation fluid with other fluids in lowering the mortality of patients with sepsis. METHODS: By searching MEDLINE, Embase, Cochrane Central Registration of Controlled Trials databases, the metaRegister of Controlled Trials, the Medical Editors Trial Amnesty Register, and retrieval of the randomized controlled trial (RCT) literature to compare the result of resuscitation using albumin-containing fluid and other fluids. The study population included adult patients who were diagnosed to have sepsis, and the patients with sepsis who were studied as subgroup. The RevMan 5.0 software was used for Meta-analysis, and the main outcome was the mortality of the hospitalized patients. RESULTS: In the 14 RCTs, 1729 patients received the albumin-containing fluid resuscitation or resuscitation with other fluids. It was found that the patients with sepsis were the only research objects in five studies, and in other nine studies patients with sepsis were studied as subgroup. P = 0.98, I (2)=0%, i.e. no heterogenicity, and the fixed effect model was used for combining results. There was no evident difference between the group of patients with sepsis resuscitated by albumin-containing fluids and other fluids [odds ratio (OR) was 0.87, 95% confidence interval (95%CI) 0.71-1.07, P = 0.18]. The pooled OR of resuscitation using high concentration albumin solution (20%) was 1.11, 95%CI 0.71-1.73, P = 0.65, the pooled OR of resuscitation using low concentration albumin solution (4%, 5%) was 0.82, 95%CI 0.65-1.03, P = 0.09. Resuscitation with different concentration of albumin-containing fluids was identical with the whole research results. After rejecting six articles of Boldt and other authors, and also saline versus albumin fluid evaluation (SAFE) study, the sensitivity analysis of the study was performed in order to check whether the data produced decisive significance to the whole research results or not. The whole results did not change after their rejection(Boldt studies were rejected:OR 0.82, 95%CI 0.65-1.02, P = 0.08; SAFE study was rejected: OR 1.05, 95%CI 0.71-1.55, P = 0.82). Therefore the analysis results were satisfactory. CONCLUSION: The Meta-analysis shows that by using albumin-containing fluids for resuscitation can not lower the mortality of sepsis as compared with other fluids.