Pagano Monica B, Harmon Charles, Cooling Laura, Connelly-Smith Laura, Mann Steven A, Pham Huy P, Marques Marisa B, Schlueter Annette J, Case Rosemary, King Karen E, Cataife Guido, Wu Yanyun, Wong Edward C C, Winters Jeffrey L
Department of Laboratory Medicine, University of Washington, Seattle, Washington.
Department of Pathology, University of Michigan, Ann Arbor, Michigan.
Transfusion. 2016 Nov;56(11):2848-2856. doi: 10.1111/trf.13795. Epub 2016 Sep 7.
Hydroxyethyl starch (HES) is reportedly associated with an increased risk of renal failure and death when used for fluid resuscitation in critically ill patients. HES can be used during therapeutic leukocytapheresis (TL) procedures to enhance cell separation. The purpose of this study was to evaluate the occurrence of adverse events associated with HES during TL procedures.
We performed a retrospective review of patients who underwent TL with and without HES in the period 2009 to 2013 at six academic medical institutions.
A difference-in-difference regression analysis was used to estimate the mean change before and after TL in selected outcomes in the HES group relative to the average change in the non-HES group. Selected outcomes included serum creatinine, estimated glomerular filtration rate (eGFR), and white blood cell (WBC) count. A total of 195 patients who underwent 278 TL procedures were studied. We found no significant differences in serum creatinine levels and eGFR on Days 1 and 7 after TL procedure between patients who received and those who did not receive HES. The rate of adverse events and overall and early mortality were similar in both groups. Patients with acute myeloid leukemia who received HES had greater WBC reduction when HES was used. Additionally, patients who received HES had improvement in pulmonary leukostasis symptoms.
HES, used at low doses during TL procedures, was not associated with adverse events previously ascribed to its use as a volume expander.
据报道，羟乙基淀粉（HES）用于危重症患者的液体复苏时，与肾衰竭和死亡风险增加相关。HES可用于治疗性白细胞去除术（TL）过程中以增强细胞分离。本研究的目的是评估TL过程中与HES相关的不良事件的发生情况。
我们对2009年至2013年期间在六家学术医疗机构接受或未接受HES进行TL的患者进行了回顾性研究。
采用差异-差异回归分析来估计HES组选定结局在TL前后的平均变化相对于非HES组的平均变化。选定的结局包括血清肌酐、估计肾小球滤过率（eGFR）和白细胞（WBC）计数。共研究了195例接受278次TL手术的患者。我们发现接受HES和未接受HES的患者在TL手术后第1天和第7天的血清肌酐水平和eGFR无显著差异。两组的不良事件发生率、总体死亡率和早期死亡率相似。接受HES的急性髓系白血病患者在使用HES时白细胞减少更明显。此外，接受HES的患者肺部白细胞淤滞症状有所改善。
在TL过程中低剂量使用HES与先前归因于其作为容量扩张剂使用的不良事件无关。
