BACKGROUND Patients with sepsis typically require large resuscitation volumes, but the optimal type of fluid remains unclear. The aim of this systematic review was to evaluate current evidence on the effectiveness and safety of hydroxyethyl starch for fluid management in sepsis. METHODS Computer searches of MEDLINE, EMBASE and the Cochrane Library were performed using search terms that included hydroxyethyl starch; hetastarch; shock, septic; sepsis; randomized controlled trials; and random allocation. Additional methods were examination of reference lists and hand searching. Randomized clinical trials comparing hydroxyethyl starch with other fluids in patients with sepsis were selected. Data were extracted on numbers of patients randomized, specific indication, fluid regimen, follow-up, endpoints, hydroxyethyl starch volume infused and duration of administration, and major study findings. RESULTS Twelve randomized trials involving a total of 1062 patients were included. Ten trials (83%) were acute studies with observation periods of 5 days or less, most frequently assessing cardiorespiratory and hemodynamic variables. Two trials were designed as outcome studies with follow-up for 34 and 90 days, respectively. Hydroxyethyl starch increased the incidence of acute renal failure compared both with gelatin (odds ratio, 2.57; 95% confidence interval, 1.13-5.83) and crystalloid (odds ratio, 1.81; 95% confidence interval, 1.22-2.71). In the largest and most recent trial a trend was observed toward increased overall mortality among hydroxyethyl starch recipients (odds ratio, 1.35; 95% confidence interval, 0.94-1.95), and mortality was higher (p < 0.001) in patients receiving > 22 mL.kg-1 hydroxyethyl starch per day than lower doses. CONCLUSION Hydroxyethyl starch increases the risk of acute renal failure among patients with sepsis and may also reduce the probability of survival. While the evidence reviewed cannot necessarily be applied to other clinical indications, hydroxyethyl starch should be avoided in sepsis.

中文翻译：

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使用羟乙基淀粉进行脓毒症液体管理的随机临床试验的系统评价。

背景 脓毒症患者通常需要大量复苏液，但最佳液体类型仍不清楚。本系统评价的目的是评估羟乙基淀粉用于脓毒症液体管理的有效性和安全性的当前证据。方法 使用包括羟乙基淀粉的搜索词对 MEDLINE、EMBASE 和 Cochrane 图书馆进行计算机搜索；羟乙基淀粉; 休克，败血症；败血症；随机对照试验; 和随机分配。其他方法是检查参考列表和手动搜索。选择了在脓毒症患者中比较羟乙基淀粉与其他液体的随机临床试验。提取关于随机化患者数量、特定适应症、液体方案、随访、终点、羟乙基淀粉的输注量和给药持续时间，以及主要研究结果。结果 共纳入 12 项随机试验，涉及 1062 名患者。十项试验 (83%) 是观察期为 5 天或更短的急性研究，最常见的是评估心肺和血液动力学变量。两项试验被设计为结果研究，分别进行了 34 天和 90 天的随访。与明胶（优势比，2.57；95% 置信区间，1.13-5.83）和晶体（优势比，1.81；95% 置信区间，1.22-2.71）相比，羟乙基淀粉增加了急性肾功能衰竭的发生率。在最大和最近的试验中，观察到羟乙基淀粉接受者总体死亡率增加的趋势（优势比，1.35；95% 置信区间，0.94-1.95），每天接受> 22 mL.kg-1 羟乙基淀粉的患者的死亡率高于较低剂量的患者（p < 0.001）。结论 羟乙基淀粉会增加脓毒症患者发生急性肾功能衰竭的风险，也可能降低生存概率。虽然审查的证据不一定适用于其他临床适应症，但在脓毒症中应避免使用羟乙基淀粉。