title: Safety evaluation on low-molecular-weight hydroxyethyl starch for volume expansion therapy in pediatric patients: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  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.
authors.affiliation: Department of Pharmacy, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Kongjiang Road 1665, Shanghai, 200092, China. llxlyy88@sina.com.
authors.forename: Lixia
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China. llxlyy@sina.com.
authors.forename: Yongyang
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Epidemiology, Shanghai Jiaotong University School of Medicine, Kongjiang Road 1665, Shanghai, 200092, China. xiaoxingxu1@sina.com.
authors.forename: Xiaoxing
authors.initials: X
authors.lastname: Xu
authors.affiliation: Department of Anesthesiology and SICU, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Kongjiang Road 1665, Shanghai, 200092, China. xubo-mazui@163.com.
authors.forename: Bo
authors.initials: B
authors.lastname: Xu
authors.affiliation: Department of Anesthesiology and SICU, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Kongjiang Road 1665, Shanghai, 200092, China. lingximengfei@126.com.
authors.forename: Rongrong
authors.initials: R
authors.lastname: Ren
authors.affiliation: Department of Pharmacy, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Kongjiang Road 1665, Shanghai, 200092, China. liuyan160@163.com.
authors.forename: Yan
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Pharmacy, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Kongjiang Road 1665, Shanghai, 200092, China. zj_boss@126.com.
authors.forename: Jian
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Anesthesiology and SICU, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Kongjiang Road 1665, Shanghai, 200092, China. hebinicu@139.com.
authors.forename: Bin
authors.initials: B
authors.lastname: He
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced; D001499:Bayes Theorem; D001810:Blood Volume; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D007223:Infant; D007902:Length of Stay; D010952:Plasma Substitutes / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D010976:Platelet Count; D016032:Randomized Controlled Trials as Topic
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes