Bansal M, Farrugia A, Balboni S, Martin G
Plasma Protein Therapeutics Association, Global Access, 147 Old Solomons Island Road Suite #100, Annapolis, MD 21401, USA.
Curr Drug Saf. 2013 Sep;8(4):236-45. doi: 10.2174/15748863113089990046.
Fluid resuscitation is widely practiced in intensive care units for the treatment of sepsis. A comparison of the evidence base of different fluids may inform therapeutic choice.
The risks of mortality and morbidity (the need for renal replacement therapies (RRT)) were assessed in patients with severe sepsis. A network meta-analysis compared trials for crystalloids, albumin and hydroxyethyl starch (HES). A literature search of human randomized clinical trials was conducted in databases, the bibliographies of other recent relevant systematic reviews and data reported at recent conferences. Mortality outcomes and RRT data with the longest follow up period were compared. A Bayesian network meta-analysis assessed the risk of mortality and a pair-wise metaanalysis assessed RRT using crystalloids as the reference treatment.
13 studies were identified. A fixed-effects meta-analysis of mortality data in the trials demonstrated an odds-ratio (OR) of 0.90 between crystalloids and albumin, 1.25 between crystalloids and HES and 1.40 between albumin and HES. The probability that albumin is associated with the highest survival was 96.4% followed by crystalloid at 3.6%, with a negligible probability for HES. Sub-group analyses demonstrated the robustness of this result to variations in fluid composition, study source and origin of septic shock. A random-effects pairwise comparison for the risk of RRT provided an OR of 1.52 favoring crystalloid over HES.
Fluid therapy with albumin was associated with the highest survival benefit. The higher morbidity with HES may affect mortality and requires consideration by prescribers.
在重症监护病房中，液体复苏广泛应用于脓毒症的治疗。比较不同液体的循证依据可能有助于指导治疗选择。
对严重脓毒症患者的死亡率和发病率（肾脏替代治疗（RRT）需求）风险进行评估。一项网状Meta分析比较了晶体液、白蛋白和羟乙基淀粉（HES）的试验。在数据库、其他近期相关系统评价的参考文献以及近期会议报告的数据中对人类随机临床试验进行文献检索。比较随访期最长的死亡率结果和RRT数据。一项贝叶斯网状Meta分析评估死亡率风险，一项成对Meta分析以晶体液作为对照治疗评估RRT。
共纳入13项研究。对试验中的死亡率数据进行固定效应Meta分析显示，晶体液与白蛋白之间的比值比（OR）为0.90，晶体液与HES之间为1.25，白蛋白与HES之间为1.40。白蛋白与最高生存率相关的概率为96.4%，其次是晶体液，为3.6%，HES的概率可忽略不计。亚组分析表明该结果对于液体成分、研究来源和脓毒性休克的起源的变化具有稳健性。对RRT风险进行随机效应成对比较得出的OR为1.52，表明晶体液优于HES。
白蛋白液体治疗具有最高的生存获益。HES较高的发病率可能影响死亡率，需要处方医生予以考虑。
