Association of 6% hetastarch resuscitation with adverse outcomes in critically ill trauma patients

Matthew E. Lissauer, Albert Chi, Mary E. Kramer, Thomas M. Scalea, Steven B. Johnson

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Background Six percent hetastarch is used as a volume expander but has been associated with poor outcomes. The aim of this study was to evaluate trauma patients resuscitated with hetastarch. Methods A retrospective review was performed of adult trauma patients. Demographics, injury severity, laboratory values, outcomes, and hetastarch use were recorded. Results A total of 2,225 patients were identified, of whom 497 (22%) received hetastarch. There were no differences in age, gender, injury mechanism, lactate, hematocrit, or creatinine. The mean injury severity score was different: 29.7 ± 12.6 with hetastarch versus 27.5 ± 12.6 without hetastarch. Acute kidney injury developed in 65 hetastarch patients (13%) and in 131 (8%) without hetastarch (relative risk, 1.73; 95% confidence interval [CI], 1.30-2.28). Hetastarch mortality was 21%, compared with 11% without hetastarch (relative risk, 1.84; 95% CI, 1.48-2.29). Multivariate logistic regression demonstrated hetastarch use (odds ratio, 1.96; 95% CI, 1.49-2.58) as independently significant for death. Hetastarch use was independently significant for renal dysfunction as well (odds ratio, 1.70; 95% CI, 1.22-2.36). Conclusions Because of the detrimental association with renal function and mortality, hetastarch should be avoided in the resuscitation of trauma patients.

Original languageEnglish (US)
Pages (from-to)53-58
Number of pages6
JournalAmerican journal of surgery
Volume202
Issue number1
DOIs
StatePublished - Jan 1 2011
Externally publishedYes

Fingerprint

Hydroxyethyl Starch Derivatives
Critical Illness
Resuscitation
Wounds and Injuries
Confidence Intervals
Odds Ratio
Kidney
Injury Severity Score
Mortality
Hematocrit
Acute Kidney Injury

Keywords

  • Hetastarch
  • Shock/hemorrhage
  • Traumatology
  • Wounds and injuries

ASJC Scopus subject areas

  • Surgery

Cite this

Association of 6% hetastarch resuscitation with adverse outcomes in critically ill trauma patients. / Lissauer, Matthew E.; Chi, Albert; Kramer, Mary E.; Scalea, Thomas M.; Johnson, Steven B.

In: American journal of surgery, Vol. 202, No. 1, 01.01.2011, p. 53-58.

Research output: Contribution to journalArticle

Lissauer, Matthew E. ; Chi, Albert ; Kramer, Mary E. ; Scalea, Thomas M. ; Johnson, Steven B. / Association of 6% hetastarch resuscitation with adverse outcomes in critically ill trauma patients. In: American journal of surgery. 2011 ; Vol. 202, No. 1. pp. 53-58.
@article{3da22faa94524e3995944ad150179f3f,
title = "Association of 6{\%} hetastarch resuscitation with adverse outcomes in critically ill trauma patients",
abstract = "Background Six percent hetastarch is used as a volume expander but has been associated with poor outcomes. The aim of this study was to evaluate trauma patients resuscitated with hetastarch. Methods A retrospective review was performed of adult trauma patients. Demographics, injury severity, laboratory values, outcomes, and hetastarch use were recorded. Results A total of 2,225 patients were identified, of whom 497 (22{\%}) received hetastarch. There were no differences in age, gender, injury mechanism, lactate, hematocrit, or creatinine. The mean injury severity score was different: 29.7 ± 12.6 with hetastarch versus 27.5 ± 12.6 without hetastarch. Acute kidney injury developed in 65 hetastarch patients (13{\%}) and in 131 (8{\%}) without hetastarch (relative risk, 1.73; 95{\%} confidence interval [CI], 1.30-2.28). Hetastarch mortality was 21{\%}, compared with 11{\%} without hetastarch (relative risk, 1.84; 95{\%} CI, 1.48-2.29). Multivariate logistic regression demonstrated hetastarch use (odds ratio, 1.96; 95{\%} CI, 1.49-2.58) as independently significant for death. Hetastarch use was independently significant for renal dysfunction as well (odds ratio, 1.70; 95{\%} CI, 1.22-2.36). Conclusions Because of the detrimental association with renal function and mortality, hetastarch should be avoided in the resuscitation of trauma patients.",
keywords = "Hetastarch, Shock/hemorrhage, Traumatology, Wounds and injuries",
author = "Lissauer, {Matthew E.} and Albert Chi and Kramer, {Mary E.} and Scalea, {Thomas M.} and Johnson, {Steven B.}",
year = "2011",
month = "1",
day = "1",
doi = "10.1016/j.amjsurg.2010.05.002",
language = "English (US)",
volume = "202",
pages = "53--58",
journal = "American Journal of Surgery",
issn = "0002-9610",
publisher = "Elsevier Inc.",
number = "1",

}

TY - JOUR

T1 - Association of 6% hetastarch resuscitation with adverse outcomes in critically ill trauma patients

AU - Lissauer, Matthew E.

AU - Chi, Albert

AU - Kramer, Mary E.

AU - Scalea, Thomas M.

AU - Johnson, Steven B.

PY - 2011/1/1

Y1 - 2011/1/1

N2 - Background Six percent hetastarch is used as a volume expander but has been associated with poor outcomes. The aim of this study was to evaluate trauma patients resuscitated with hetastarch. Methods A retrospective review was performed of adult trauma patients. Demographics, injury severity, laboratory values, outcomes, and hetastarch use were recorded. Results A total of 2,225 patients were identified, of whom 497 (22%) received hetastarch. There were no differences in age, gender, injury mechanism, lactate, hematocrit, or creatinine. The mean injury severity score was different: 29.7 ± 12.6 with hetastarch versus 27.5 ± 12.6 without hetastarch. Acute kidney injury developed in 65 hetastarch patients (13%) and in 131 (8%) without hetastarch (relative risk, 1.73; 95% confidence interval [CI], 1.30-2.28). Hetastarch mortality was 21%, compared with 11% without hetastarch (relative risk, 1.84; 95% CI, 1.48-2.29). Multivariate logistic regression demonstrated hetastarch use (odds ratio, 1.96; 95% CI, 1.49-2.58) as independently significant for death. Hetastarch use was independently significant for renal dysfunction as well (odds ratio, 1.70; 95% CI, 1.22-2.36). Conclusions Because of the detrimental association with renal function and mortality, hetastarch should be avoided in the resuscitation of trauma patients.

AB - Background Six percent hetastarch is used as a volume expander but has been associated with poor outcomes. The aim of this study was to evaluate trauma patients resuscitated with hetastarch. Methods A retrospective review was performed of adult trauma patients. Demographics, injury severity, laboratory values, outcomes, and hetastarch use were recorded. Results A total of 2,225 patients were identified, of whom 497 (22%) received hetastarch. There were no differences in age, gender, injury mechanism, lactate, hematocrit, or creatinine. The mean injury severity score was different: 29.7 ± 12.6 with hetastarch versus 27.5 ± 12.6 without hetastarch. Acute kidney injury developed in 65 hetastarch patients (13%) and in 131 (8%) without hetastarch (relative risk, 1.73; 95% confidence interval [CI], 1.30-2.28). Hetastarch mortality was 21%, compared with 11% without hetastarch (relative risk, 1.84; 95% CI, 1.48-2.29). Multivariate logistic regression demonstrated hetastarch use (odds ratio, 1.96; 95% CI, 1.49-2.58) as independently significant for death. Hetastarch use was independently significant for renal dysfunction as well (odds ratio, 1.70; 95% CI, 1.22-2.36). Conclusions Because of the detrimental association with renal function and mortality, hetastarch should be avoided in the resuscitation of trauma patients.

KW - Hetastarch

KW - Shock/hemorrhage

KW - Traumatology

KW - Wounds and injuries

UR - http://www.scopus.com/inward/record.url?scp=79960185226&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79960185226&partnerID=8YFLogxK

U2 - 10.1016/j.amjsurg.2010.05.002

DO - 10.1016/j.amjsurg.2010.05.002

M3 - Article

C2 - 21600555

AN - SCOPUS:79960185226

VL - 202

SP - 53

EP - 58

JO - American Journal of Surgery

JF - American Journal of Surgery

SN - 0002-9610

IS - 1

ER -