Mortality after hydroxyethyl starch 130/0.4 infusion: an updated meta-analysis of randomized trials
BACKGROUND: Hydroxyethyl starch (HES) is in widespread clinical use for volume therapy with colloids. According to the most recent meta-analysis performed in 2010, published studies are of poor quality and report too few events to reliably estimate the benefits or risks of administering 6% HES...
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SMW supporting association (Trägerverein Swiss Medical Weekly SMW)
2012-07-01
|
| Series: | Swiss Medical Weekly |
| Subjects: | |
| Online Access: | https://www.smw.ch/index.php/smw/article/view/1555 |
| _version_ | 1798003485774446592 |
|---|---|
| author | Christian Josef Wiedermann Michael Joannidis |
| author_facet | Christian Josef Wiedermann Michael Joannidis |
| author_sort | Christian Josef Wiedermann |
| collection | DOAJ |
| description |
BACKGROUND: Hydroxyethyl starch (HES) is in widespread clinical use for volume therapy with colloids. According to the most recent meta-analysis performed in 2010, published studies are of poor quality and report too few events to reliably estimate the benefits or risks of administering 6% HES 130/0.4. As results from new trials, reporting on a large number of events became available in 2011 and 2012, an updated meta-analysis was performed.
METHODS: Randomised controlled trials comparing the effects of 6% HES 130/0.4 with other colloid or crystalloid solutions were analysed for pooled effect size on mortality in eligible studies published up to 20 February 2012.
RESULTS: Overall, 13 studies reporting 1,131 participants met the inclusion criteria. The weight of evidence contributed by the two new trials was 51.3%. The pooled relative risk (RR) for mortality increased to 1.14 with a 95% confidence interval (CI) of 0.89 to 1.46. Publication bias favoring HES 130/0.4 was present (p = 0.038). Adjustment for the observed publication bias increased the RR for mortality to 1.25 (CI, 0.98 to 1.58; p = 0.069). No heterogeneity was found (I2, 0%; CI, 0% to 32%; p = 0.81).
CONCLUSIONS: Large-scale trials should help more precisely to determine the effect of HES 130/0.4 on mortality. In the interim, best current evidence suggests a trend toward higher mortality among HES 130/0.4 recipients.
|
| first_indexed | 2024-04-11T12:08:22Z |
| format | Article |
| id | doaj.art-52020131b7b74be7b4e0edf54223eb6e |
| institution | Directory Open Access Journal |
| issn | 1424-3997 |
| language | English |
| last_indexed | 2024-04-11T12:08:22Z |
| publishDate | 2012-07-01 |
| publisher | SMW supporting association (Trägerverein Swiss Medical Weekly SMW) |
| record_format | Article |
| series | Swiss Medical Weekly |
| spelling | doaj.art-52020131b7b74be7b4e0edf54223eb6e2022-12-22T04:24:40ZengSMW supporting association (Trägerverein Swiss Medical Weekly SMW)Swiss Medical Weekly1424-39972012-07-01142313210.4414/smw.2012.13656Mortality after hydroxyethyl starch 130/0.4 infusion: an updated meta-analysis of randomized trialsChristian Josef WiedermannMichael Joannidis BACKGROUND: Hydroxyethyl starch (HES) is in widespread clinical use for volume therapy with colloids. According to the most recent meta-analysis performed in 2010, published studies are of poor quality and report too few events to reliably estimate the benefits or risks of administering 6% HES 130/0.4. As results from new trials, reporting on a large number of events became available in 2011 and 2012, an updated meta-analysis was performed. METHODS: Randomised controlled trials comparing the effects of 6% HES 130/0.4 with other colloid or crystalloid solutions were analysed for pooled effect size on mortality in eligible studies published up to 20 February 2012. RESULTS: Overall, 13 studies reporting 1,131 participants met the inclusion criteria. The weight of evidence contributed by the two new trials was 51.3%. The pooled relative risk (RR) for mortality increased to 1.14 with a 95% confidence interval (CI) of 0.89 to 1.46. Publication bias favoring HES 130/0.4 was present (p = 0.038). Adjustment for the observed publication bias increased the RR for mortality to 1.25 (CI, 0.98 to 1.58; p = 0.069). No heterogeneity was found (I2, 0%; CI, 0% to 32%; p = 0.81). CONCLUSIONS: Large-scale trials should help more precisely to determine the effect of HES 130/0.4 on mortality. In the interim, best current evidence suggests a trend toward higher mortality among HES 130/0.4 recipients. https://www.smw.ch/index.php/smw/article/view/1555colloidscritical illnessfluid resuscitationhemodynamic instabilityintensive care unit.mortality |
| spellingShingle | Christian Josef Wiedermann Michael Joannidis Mortality after hydroxyethyl starch 130/0.4 infusion: an updated meta-analysis of randomized trials Swiss Medical Weekly colloids critical illness fluid resuscitation hemodynamic instability intensive care unit. mortality |
| title | Mortality after hydroxyethyl starch 130/0.4 infusion: an updated meta-analysis of randomized trials |
| title_full | Mortality after hydroxyethyl starch 130/0.4 infusion: an updated meta-analysis of randomized trials |
| title_fullStr | Mortality after hydroxyethyl starch 130/0.4 infusion: an updated meta-analysis of randomized trials |
| title_full_unstemmed | Mortality after hydroxyethyl starch 130/0.4 infusion: an updated meta-analysis of randomized trials |
| title_short | Mortality after hydroxyethyl starch 130/0.4 infusion: an updated meta-analysis of randomized trials |
| title_sort | mortality after hydroxyethyl starch 130 0 4 infusion an updated meta analysis of randomized trials |
| topic | colloids critical illness fluid resuscitation hemodynamic instability intensive care unit. mortality |
| url | https://www.smw.ch/index.php/smw/article/view/1555 |
| work_keys_str_mv | AT christianjosefwiedermann mortalityafterhydroxyethylstarch13004infusionanupdatedmetaanalysisofrandomizedtrials AT michaeljoannidis mortalityafterhydroxyethylstarch13004infusionanupdatedmetaanalysisofrandomizedtrials |