In this well-designed review and meta-analysis, the authors assess the available evidence on the use of hydroxyethyl starch 130/0.38-0.45 versus crystalloid or albumin in patients with severe sepsis. After reviewing 9 highly selected, randomized or quasi-randomized trials, 3456 patients were finally included in the analysis. The objective was to assess the effects of both therapies on all-cause mortality, kidney injury, bleeding and serious adverse events.

Even though the pooled analysis of mortality showed neither benefit nor harm, the risk of being transfused with red blood cells and of receiving renal replacement therapy were significantly higher in the group of patients treated with hydroxyethyl starch.

This article corroborates the recently published trials documenting the negative consequences of the infusion of hydroxyethyl starch on clinical outcomes in critically ill patients. It is well written, easy to read, and it clearly shows that, pending new evidence, resuscitation with crystalloids should be preferred in patients with severe sepsis.

– Santiago Ramón Leal-Noval