TITLE

Systematic analysis of hydroxyethyl starch (HES) reviews: proliferation of low-quality reviews overwhelms the results of well-performed meta-analyses

AUTHOR(S)
Hartog, Christiane; Skupin, Helga; Natanson, Charles; Sun, Junfeng; Reinhart, Konrad
PUB. DATE
August 2012
SOURCE
Intensive Care Medicine;Aug2012, Vol. 38 Issue 8, p1258
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Purpose: Hydroxyethyl starch (HES) is a synthetic colloid used widely for resuscitation despite the availability of safer, less costly fluids. Numerous HES reviews have been published that may have influenced clinicians' practice. We have therefore examined the relationship between the methodological quality of published HES reviews, authors' potential conflicts of interest (pCOI) and the recommendations made. Methods: Systematic analysis of reviews on HES use. Results: Between 1975 and 2010, 165 reviews were published containing recommendations for or against HES use. From the 1990s onwards, favorable reviews increased from two to eight per year and HES's share of the artificial colloid market tripled from 20 to 60 %. Only 7 % (12/165) of these reviews of HES use contained meta-analyses; these 7 % had higher Overview Quality Assessment Questionnaire (OQAQ) scores [median (range) 6.5 (3-7)] than reviews without meta-analysis [2 (1-4); p < 0.001]. The rates of recommending against HES use are 83 % (10/12) in meta-analyses and 20 % (31/153) in reviews without meta-analysis ( p < 0.0001). Fourteen authors published the majority (70/124) of positive reviews, and ten of these 14 had or have since developed a pCOI with various manufacturers of HES. Conclusions: Low-quality HES reviews reached different conclusions than high-quality meta-analyses from independent entities, such as Cochrane Reviews. The majority of these low-quality positive HES reviews were written by a small group of authors, most of whom had or have since established ties to industry. The proliferation of positive HES reviews has been associated with increased utilization of an expensive therapy despite the lack of evidence for meaningful clinical benefit and increased risks. Clinicians need to be more informed that marketing efforts are potentially influencing scientific literature.
ACCESSION #
77873230

Tags: HYDROXYETHYL starch -- Therapeutic use;  META-analysis;  RESUSCITATION;  CRITICAL care medicine;  COLLOIDS -- Therapeutic use;  BLOOD plasma substitutes

 

Related Articles

  • Fluids: what's new? Redhi, L. // South African Family Practice;May/Jun2013, Vol. 55 Issue 3, pS28 

    The article discusses the use of crystalloids, human albumin (HA), and non-protein or synthetic colloids in fluid replacement and resuscitation in the intraoperative settings. An overview of the types of fluids is offered. Details on the contents of colloids, the benefits of HA and advantages of...

  • Effects of hydroxyethyl starch in subgroups of patients with severe sepsis: exploratory post-hoc analyses of a randomised trial. Müller, Rasmus; Haase, Nicolai; Wetterslev, Jørn; Perner, Anders // Intensive Care Medicine; 

    Purpose: It has been speculated that certain subgroups of sepsis patients may benefit from treatment with hydroxyethyl starch (HES) 130/0.42, specifically in the earlier resuscitation of patients with more severely impaired circulation. Methods: This was a post-hoc, subgroup analysis of all 798...

  • Colloids in the intensive care unit. Kruer, Rachel M.; Ensor, Christopher R. // American Journal of Health-System Pharmacy;10/1/2012, Vol. 69 Issue 19, p1635 

    Purpose. The most recent published evidence on the use of colloids versus crystalloids in critical care is reviewed, with a focus on population-dependent differences in safety and efficacy. Summary. Colloids offer a number of theoretical advantages over crystalloids for fluid resuscitation, but...

  • Hydroxyethyl Starch 130/0.42 versus Ringer's Acetate in Severe Sepsis. Perner, Anders; Haase, Nicolai; Guttormsen, Anne B.; Tenhunen, Jyrki; Klemenzson, Gudmundur; �neman, Anders; Madsen, Kristian R.; M�ller, Morten H.; Elkj�r, Jeanie M.; Poulsen, Lone M.; Bendtsen, Asger; Winding, Robert; Steensen, Morten; Berezowicz, Pawel; S�e-Jensen, Peter; Bestle, Morten; Strand, Kristian; Wiis, J�rgen; White, Jonathan O.; Thornberg, Klaus J. // New England Journal of Medicine;7/12/2012, Vol. 367 Issue 2, p124 

    Background: Hydroxyethyl starch (HES) 130/0.42 is widely used for fluid resuscitation in intensive care units (ICUs), but its safety and efficacy have not been established in patients with severe sepsis. Methods: In this multicenter, parallel-group, blinded trial, we randomly assigned patients...

  • Hydroxyethyl starch 130/0.4 and saline did not differ for mortality at 90 days in ICU patients. Lauzier, François // Annals of Internal Medicine;3/19/2013, Vol. 158 Issue 6, pJC5 

    The article studies the effect of 6 percent hydroxyethyl starch with ratio 130-0.4 as compared with saline for fluid resuscitation. It informs that 7000 thousand intensive care unit (ICU) patients of more that 18 years of age requiring fluid resuscitation were diagnosed. The result showed that...

  • Review: Hydroxyethyl starch increases mortality and acute kidney injury in critically ill patients. Zarychanski, R.; Myburgh, John // Annals of Internal Medicine;6/18/2013, Vol. 158 Issue 12, pJC4 

    The article reviews studies which examined the efficacy and safety of hydroxyethyl starch (HES) solutions in critically ill patients receiving acute volume resuscitation. These studies compared HES with intravenous (IV) solutions for acute resuscitation based on randomized clinical trials (RCT)...

  • Bleeding and risk of death with hydroxyethyl starch in severe sepsis: post hoc analyses of a randomized clinical trial. Haase, Nicolai; Wetterslev, Jørn; Winkel, Per; Perner, Anders // Intensive Care Medicine;Dec2013, Vol. 39 Issue 12, p2126 

    Purpose: We aimed to characterize the degree and clinical importance of bleeding in patients treated with hydroxyethyl starch (HES). Methods: In post hoc analyses, we examined the associations between fluid assignment, hemostatic variables, bleeding events, transfusions, and death among 798...

  • Použití pÅ™irozených koloidů v tekutinové resuscitaci těžce popálených pacientů. Fridrichova, L.; Lipový, B.; Brychta, P. // Transfusiology & Haematology Today / Transfuze a Hematologie Dne;Dec2012, Vol. 18 Issue 4, p169 

    Objective: The amount of natural colloids (albumin and fresh frozen plasma) administered during fluid resuscitation of burn patients is influenced by many factors. The most frequently cited include extent of the burned areas, presence of inhalation injury and age. The aim of our study was to...

  • Benefits and risks of using gelatin solution as a plasma expander for perioperative and critically ill patients: a meta-analysis. Saw, M. M.; Chandler, B.; Ho, K. M. // Anaesthesia & Intensive Care;Jan2012, Vol. 40 Issue 1, p17 

    The article presents a study on the application of gelatin solutions for patients in perioperative and critical care settings. It discusses findings based on a meta-analysis on the use of gelatin solution for resuscitation compared with other intravenous liquids for patients undergoing major...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics