Safety evaluation on low-molecular-weight hydroxyethyl starch for volume expansion therapy in pediatric patients: a meta-analysis of randomized controlled trials

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• 作者：Lixia Li (1)
  Yongyang Li (2)
  Xiaoxing Xu (3)
  Bo Xu (4)
  Rongrong Ren (4)
  Yan Liu (1)
  Jian Zhang (1)
  Bin He (4)
  
  1. Department of Pharmacy ; Xinhua Hospital ; Shanghai Jiaotong University School of Medicine ; Kongjiang Road 1665 ; Shanghai ; 200092 ; China
  2. Department of Surgery ; Shanghai Jiaotong University Affiliated Sixth People鈥檚 Hospital ; Yishan Road 600 ; Shanghai ; 200233 ; China
  3. Department of Epidemiology ; Shanghai Jiaotong University School of Medicine ; Kongjiang Road 1665 ; Shanghai ; 200092 ; China
  4. Department of Anesthesiology and SICU ; Xinhua Hospital ; Shanghai Jiaotong University School of Medicine ; Kongjiang Road 1665 ; Shanghai ; 200092 ; China
  
• 刊名：Critical Care
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：19
• 期：1
• 全文大小：1,087 KB
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• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

Introduction Hydroxyethyl starch (HES) has been widely used for volume expansion, but its safety in adult patients has been questioned recently. The aim of this meta-analysis is to see whether or not HES has any adverse effect in pediatric patients. Methods Randomized controlled trials (RCTs) involving pediatric patients who received 6% low-molecular-weight HES, published before January 2014, were searched for in Pubmed, Embase database and Cochrane Library. Two reviewers independently extracted the valid data, including the mortality, renal function, coagulation, blood loss, hemodynamic changes, and length of hospital and ICU stay. All data were analyzed by I 2-test, and the results of statistical analysis were displayed in forest plots. Possible publication bias was tested by funnel plots. Bayesian analysis was performed using WinBUGS with fixed and random effects models. Results A total of 13 RCTs involving 1,156 pediatric patients were finally included in this meta-analysis. Compared with other fluids, HES did not significantly decrease the mortality (RR鈥?鈥?0.01; 95%CI: 0.05 to 0.03; P鈥?鈥?.54; I 2鈥?鈥?%), creatinine level (I 2 -test: MD鈥?鈥?.81; 95%CI: -0.35 to 3.98; P鈥?鈥?.10;I 2 鈥?鈥?%; Bayesian analysis: Fixed effect model MD鈥?鈥?.77; 95%CI: -0.07 to 3.6; Random effects model MD鈥?鈥?.78; 95%CI: -1.86 to 5.33), activated partial thromboplastin time (MD鈥?鈥?.01; 95%CI: -1.05 to 1.07; P鈥?鈥?.99; I 2鈥?鈥?2%), and blood loss (MD鈥?鈥?7.72; 95%CI: -41.27 to 5.82; P鈥?鈥?.10; I 2鈥?鈥?%) in pediatric patients. However, HES significantly decreased the blood platelet count (MD鈥?鈥?0.99; 95%CI: -32.08 to -9.90; P鈥?鈥?.0002; I 2鈥?鈥?8%) and increased the length of ICU stay (MD鈥?鈥?.94; 95%CI: 0.18 to 1.70; P鈥?鈥?.02; I 2鈥?鈥?6%). Conclusions Volume expansion with 6% HES significantly decreased the platelet count and increased the length of ICU stay, also might have an adverse effect on renal function. Therefore HES is not recommended for pediatric patients, which safety needs more high quality RCTs and studies to confirm in future.