Table 2.
Meta-analyses and systematic reviews
| Study | Number of trials | Number of patients | Population | Intervention | Control | Outcomes | Conclusion |
|---|---|---|---|---|---|---|---|
| Serpa Neto 2014 |
10 |
4,624 |
Septic patients |
HES |
Crystalloids |
28- and 90- day mortality, AKI, RRT, transfusion, LOS, fluid intake |
HES shows increase in AKI, RRT, need for RBC transfusion, and 90-day mortality |
| Zarychanski 2013 |
38 |
10,880 |
Critically ill, including sepsis, trauma, burn, hypovolemic shock |
HES |
Crystalloids, gelatin, albumin |
Mortality, AKI, LOS, MV |
After exclusion of Boldt studies, HES increased mortality, AKI, and RRT |
| Gattas 2013 |
35 |
10,391 |
Critically ill or surgical patients |
6% HES 130/0.4-0.42 |
Other fluids |
Mortality, RRT, AKI, transfusion, bleeding |
Increased risk of RRT with HES |
| Hasse 2013 |
9 |
3,456 |
ICU patients with sepsis |
6% HES 130/0.38-0.45 |
Crystalloids or albumin |
All cause mortality, RRT, AKI, bleeding and transfusion, adverse effects as defined in the individual studies |
HES increased RRT, increased blood transfusion, increased incidence of adverse effects |
| Gillies 2013 |
19 |
1,567 |
Surgical patients |
6% HES |
Other colloids or crystalloids |
Postoperative in hospital mortality, AKI, RRT |
No difference in measured outcomes, no demonstrable benefit of HES |
| Perel 2013 |
70 |
22,392 |
Cochrane review 2013, critically ill |
Colloids |
Crystalloids |
Mortality |
Colloids do not decrease mortality, HES may increase mortality |
| Mutter 2013 |
42 |
11,399 |
Cochrane review |
HES |
Other fluids |
Renal function |
Increased need for RRT with all HES products in all patient populations |
| Bunn 2012 |
86 |
5,484 |
Critically ill and surgical patients in need of volume resuscitation, Cochrane review |
Any one colloid (included albumin, HES, dextran, gelatin) |
Any other colloid (included albumin, HES, dextran, gelatin) |
Mortality, need for blood transfusion, adverse events |
No benefit of one type of colloid over another |
| Thomas-Ruedel 2012 |
40 |
3,275 |
Adult and pediatric, primarily elective surgery, as well as ICU and ED |
Gelatin |
Albumin or crystalloid |
Mortality, blood products administration, AKI, RRT |
Unable to determine safety due to small studies and large heterogeneity |
| Rochwerg 2014 | 14 | 18,916 | Adult patients with sepsis and septic shock | Any fluid (colloid or crystalloid) | Any fluid (colloid or crystalloid) | Mortality, blood products administration, AKI, RRT | Reduced mortality with balanced crystalloids and albumin compared to other fluids |
ICU, intensive care unit; HES, hydroxyethyl starch; AKI, acute kidney injury; RRT, renal replacement therapy; MV, mechanical ventilation; LOS, length of stay (ICU or hospital); ED, emergency department.