Several recent meta-analyses have suggested that hydroxyethyl starches (HES) may be associated with an increase in mortality and in the need for renal replacement therapy (RRT), specially in patients admitted to the intensive care unit for sepsis. However, this may not be true in all clinical settings, and Van der Linden and co-authors report the results of a systemic review of studies conducted in the surgical context using modern tetrastarches.
A formal search identified 59 studies including a total of 4529 patients allocated randomly to HES (2139) or comparator (2390). Mortality was not different between groups and tended (p = 0.079) to be lower in those patients receiving HES. Thirty-nine trials including 3389 patients were unable to identify an increase in renal risk (evaluated by serum creatinine or RRT). Transfusion risk was lower (p = 0.0004) in patients who received HES in 20 trials that reported allogeneic blood transfusion in 2151 patients.
Thus, as mentioned by the authors, the safety of modern tetrastarches may vary with the clinical context. At present, in the surgical context, HES appear to well tolerated and are not associated with an increase in mortality or major morbidity.
– Jean-François Hardy