Cargando…

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

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) invo...

Descripción completa

Detalles Bibliográficos
Autores principales: Li, Lixia, Li, Yongyang, Xu, Xiaoxing, Xu, Bo, Ren, Rongrong, Liu, Yan, Zhang, Jian, He, Bin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4391127/
https://www.ncbi.nlm.nih.gov/pubmed/25887704
http://dx.doi.org/10.1186/s13054-015-0815-y
_version_ 1782365767670431744
author Li, Lixia
Li, Yongyang
Xu, Xiaoxing
Xu, Bo
Ren, Rongrong
Liu, Yan
Zhang, Jian
He, Bin
author_facet Li, Lixia
Li, Yongyang
Xu, Xiaoxing
Xu, Bo
Ren, Rongrong
Liu, Yan
Zhang, Jian
He, Bin
author_sort Li, Lixia
collection PubMed
description 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 = -0.01; 95%CI: 0.05 to 0.03; P = 0.54; I(2) = 6%), creatinine level (I(2)-test: MD = 1.81; 95%CI: -0.35 to 3.98; P = 0.10;I(2) = 0%; Bayesian analysis: Fixed effect model MD = 1.77; 95%CI: -0.07 to 3.6; Random effects model MD = 1.78; 95%CI: -1.86 to 5.33), activated partial thromboplastin time (MD = 0.01; 95%CI: -1.05 to 1.07; P = 0.99; I(2) = 42%), and blood loss (MD = 17.72; 95%CI: -41.27 to 5.82; P = 0.10; I(2) = 0%) in pediatric patients. However, HES significantly decreased the blood platelet count (MD = 20.99; 95%CI: -32.08 to -9.90; P = 0.0002; I(2) = 28%) and increased the length of ICU stay (MD = 0.94; 95%CI: 0.18 to 1.70; P = 0.02; I(2) = 46%). 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13054-015-0815-y) contains supplementary material, which is available to authorized users.
format Online
Article
Text
id pubmed-4391127
institution National Center for Biotechnology Information
language English
publishDate 2015
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-43911272015-04-10 Safety evaluation on low-molecular-weight hydroxyethyl starch for volume expansion therapy in pediatric patients: a meta-analysis of randomized controlled trials Li, Lixia Li, Yongyang Xu, Xiaoxing Xu, Bo Ren, Rongrong Liu, Yan Zhang, Jian He, Bin Crit Care Research 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 = -0.01; 95%CI: 0.05 to 0.03; P = 0.54; I(2) = 6%), creatinine level (I(2)-test: MD = 1.81; 95%CI: -0.35 to 3.98; P = 0.10;I(2) = 0%; Bayesian analysis: Fixed effect model MD = 1.77; 95%CI: -0.07 to 3.6; Random effects model MD = 1.78; 95%CI: -1.86 to 5.33), activated partial thromboplastin time (MD = 0.01; 95%CI: -1.05 to 1.07; P = 0.99; I(2) = 42%), and blood loss (MD = 17.72; 95%CI: -41.27 to 5.82; P = 0.10; I(2) = 0%) in pediatric patients. However, HES significantly decreased the blood platelet count (MD = 20.99; 95%CI: -32.08 to -9.90; P = 0.0002; I(2) = 28%) and increased the length of ICU stay (MD = 0.94; 95%CI: 0.18 to 1.70; P = 0.02; I(2) = 46%). 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13054-015-0815-y) contains supplementary material, which is available to authorized users. BioMed Central 2015-03-10 2015 /pmc/articles/PMC4391127/ /pubmed/25887704 http://dx.doi.org/10.1186/s13054-015-0815-y Text en © Li et al.; licensee BioMed Central. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Li, Lixia
Li, Yongyang
Xu, Xiaoxing
Xu, Bo
Ren, Rongrong
Liu, Yan
Zhang, Jian
He, Bin
Safety evaluation on low-molecular-weight hydroxyethyl starch for volume expansion therapy in pediatric patients: a meta-analysis of randomized controlled trials
title Safety evaluation on low-molecular-weight hydroxyethyl starch for volume expansion therapy in pediatric patients: a meta-analysis of randomized controlled trials
title_full Safety evaluation on low-molecular-weight hydroxyethyl starch for volume expansion therapy in pediatric patients: a meta-analysis of randomized controlled trials
title_fullStr Safety evaluation on low-molecular-weight hydroxyethyl starch for volume expansion therapy in pediatric patients: a meta-analysis of randomized controlled trials
title_full_unstemmed Safety evaluation on low-molecular-weight hydroxyethyl starch for volume expansion therapy in pediatric patients: a meta-analysis of randomized controlled trials
title_short Safety evaluation on low-molecular-weight hydroxyethyl starch for volume expansion therapy in pediatric patients: a meta-analysis of randomized controlled trials
title_sort safety evaluation on low-molecular-weight hydroxyethyl starch for volume expansion therapy in pediatric patients: a meta-analysis of randomized controlled trials
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4391127/
https://www.ncbi.nlm.nih.gov/pubmed/25887704
http://dx.doi.org/10.1186/s13054-015-0815-y
work_keys_str_mv AT lilixia safetyevaluationonlowmolecularweighthydroxyethylstarchforvolumeexpansiontherapyinpediatricpatientsametaanalysisofrandomizedcontrolledtrials
AT liyongyang safetyevaluationonlowmolecularweighthydroxyethylstarchforvolumeexpansiontherapyinpediatricpatientsametaanalysisofrandomizedcontrolledtrials
AT xuxiaoxing safetyevaluationonlowmolecularweighthydroxyethylstarchforvolumeexpansiontherapyinpediatricpatientsametaanalysisofrandomizedcontrolledtrials
AT xubo safetyevaluationonlowmolecularweighthydroxyethylstarchforvolumeexpansiontherapyinpediatricpatientsametaanalysisofrandomizedcontrolledtrials
AT renrongrong safetyevaluationonlowmolecularweighthydroxyethylstarchforvolumeexpansiontherapyinpediatricpatientsametaanalysisofrandomizedcontrolledtrials
AT liuyan safetyevaluationonlowmolecularweighthydroxyethylstarchforvolumeexpansiontherapyinpediatricpatientsametaanalysisofrandomizedcontrolledtrials
AT zhangjian safetyevaluationonlowmolecularweighthydroxyethylstarchforvolumeexpansiontherapyinpediatricpatientsametaanalysisofrandomizedcontrolledtrials
AT hebin safetyevaluationonlowmolecularweighthydroxyethylstarchforvolumeexpansiontherapyinpediatricpatientsametaanalysisofrandomizedcontrolledtrials