{"corpus_id":5253636,"paper_sha":"55b453cefdcf9fc610ea58262479ff2a088a6b4b","doi":"10.1056/NEJMoa1209759","arxiv_id":null,"pmid":23075127,"pmcid":null,"mag_id":2170344041,"dblp_id":null,"acl_id":null,"title":"Hydroxyethyl starch or saline for fluid resuscitation in intensive care.","year":2012,"publication_date":"2012-11-14","venue":"New England Journal of Medicine","journal":{"name":"The New England journal of medicine","pages":"\n          1901-11\n        ","volume":"367 20"},"journal_issn":null,"journal_title":null,"publication_types":["Study","JournalArticle"],"pubmed_pub_types":["Journal Article","Multicenter Study","Randomized Controlled Trial","Research Support, Non-U.S. Gov't"],"s2_fields_of_study":["Medicine"],"reference_count":26,"citation_count":1394,"influential_citation_count":38,"is_open_access":true,"arxiv_categories":null,"arxiv_license":null,"arxiv_journal_ref":null,"mesh_headings":[{"d":"Adult","mj":false,"ui":"D000328"},{"d":"Aged","mj":false,"ui":"D000368"},{"d":"Creatinine","mj":false,"qs":[{"q":"blood","mj":false,"ui":"Q000097"},{"q":"urine","mj":false,"ui":"Q000652"}],"ui":"D003404"},{"d":"Critical Care","mj":false,"ui":"D003422"},{"d":"Critical Illness","mj":false,"qs":[{"q":"mortality","mj":false,"ui":"Q000401"},{"q":"therapy","mj":true,"ui":"Q000628"}],"ui":"D016638"},{"d":"Female","mj":false,"ui":"D005260"},{"d":"Fluid Therapy","mj":false,"qs":[{"q":"adverse effects","mj":false,"ui":"Q000009"},{"q":"methods","mj":true,"ui":"Q000379"}],"ui":"D005440"},{"d":"Hospital Mortality","mj":false,"ui":"D017052"},{"d":"Humans","mj":false,"ui":"D006801"},{"d":"Hydroxyethyl Starch Derivatives","mj":false,"qs":[{"q":"adverse effects","mj":false,"ui":"Q000009"},{"q":"therapeutic use","mj":true,"ui":"Q000627"}],"ui":"D006895"},{"d":"Intensive Care Units","mj":false,"ui":"D007362"},{"d":"Intention to Treat Analysis","mj":false,"ui":"D057194"},{"d":"Kidney Diseases","mj":false,"qs":[{"q":"etiology","mj":false,"ui":"Q000209"}],"ui":"D007674"},{"d":"Male","mj":false,"ui":"D008297"},{"d":"Middle Aged","mj":false,"ui":"D008875"},{"d":"Resuscitation","mj":false,"qs":[{"q":"methods","mj":false,"ui":"Q000379"}],"ui":"D012151"},{"d":"Sodium Chloride","mj":false,"qs":[{"q":"therapeutic use","mj":false,"ui":"Q000627"}],"ui":"D012965"}],"chemicals":[{"n":"Hydroxyethyl Starch Derivatives","ui":"D006895","reg":"0"},{"n":"Sodium Chloride","ui":"D012965","reg":"451W47IQ8X"},{"n":"Creatinine","ui":"D003404","reg":"AYI8EX34EU"}],"comments_corrections":null,"source_flags":5,"s2_open_access_pdf_url":"https://www.nejm.org/doi/pdf/10.1056/NEJMoa1209759?articleTools=true","s2_open_access_landing_url":"https://www.semanticscholar.org/paper/55b453cefdcf9fc610ea58262479ff2a088a6b4b","s2_open_access_license":null,"s2_open_access_status":"BRONZE","pmc_open_access_pdf_url":null,"pmc_open_access_landing_url":null,"pmc_open_access_license":null,"pmc_open_access_status":null,"unpaywall_open_access_pdf_url":null,"unpaywall_open_access_landing_url":null,"unpaywall_open_access_license":null,"unpaywall_open_access_status":null,"abstract":"BACKGROUND\nThe safety and efficacy of hydroxyethyl starch (HES) for fluid resuscitation have not been fully evaluated, and adverse effects of HES on survival and renal function have been reported.\n\n\nMETHODS\nWe randomly assigned 7000 patients who had been admitted to an intensive care unit (ICU) in a 1:1 ratio to receive either 6% HES with a molecular weight of 130 kD and a molar substitution ratio of 0.4 (130/0.4, Voluven) in 0.9% sodium chloride or 0.9% sodium chloride (saline) for all fluid resuscitation until ICU discharge, death, or 90 days after randomization. The primary outcome was death within 90 days. Secondary outcomes included acute kidney injury and failure and treatment with renal-replacement therapy.\n\n\nRESULTS\nA total of 597 of 3315 patients (18.0%) in the HES group and 566 of 3336 (17.0%) in the saline group died (relative risk in the HES group, 1.06; 95% confidence interval [CI], 0.96 to 1.18; P=0.26). There was no significant difference in mortality in six predefined subgroups. Renal-replacement therapy was used in 235 of 3352 patients (7.0%) in the HES group and 196 of 3375 (5.8%) in the saline group (relative risk, 1.21; 95% CI, 1.00 to 1.45; P=0.04). In the HES and saline groups, renal injury occurred in 34.6% and 38.0% of patients, respectively (P=0.005), and renal failure occurred in 10.4% and 9.2% of patients, respectively (P=0.12). HES was associated with significantly more adverse events (5.3% vs. 2.8%, P<0.001).\n\n\nCONCLUSIONS\nIn patients in the ICU, there was no significant difference in 90-day mortality between patients resuscitated with 6% HES (130/0.4) or saline. However, more patients who received resuscitation with HES were treated with renal-replacement therapy. (Funded by the National Health and Medical Research Council of Australia and others; CHEST ClinicalTrials.gov number, NCT00935168.).","claims":[{"public_id":"cl_49b552fe5e3913ec685babeaa66ef99b","status":"active","text":"Acute kidney injury occurred less often in the hydroxyethyl starch group than in the saline group, while renal failure did not differ significantly between groups.","confidence":0.93,"contributors":[{"id":1,"public_id":"12632b8b5f","public_label":"Anonymous (12632b8b5f)","roles":["extraction"],"url":"https://sah.borca.ai/u/12632b8b5f"}],"url":"https://sah.borca.ai/claims/cl_49b552fe5e3913ec685babeaa66ef99b"},{"public_id":"cl_b3cc67780ca1c549c259f4e020b78ca7","status":"active","text":"Hydroxyethyl starch was associated with significantly more adverse events than saline.","confidence":0.95,"contributors":[{"id":1,"public_id":"12632b8b5f","public_label":"Anonymous (12632b8b5f)","roles":["extraction"],"url":"https://sah.borca.ai/u/12632b8b5f"}],"url":"https://sah.borca.ai/claims/cl_b3cc67780ca1c549c259f4e020b78ca7"},{"public_id":"cl_9a947649dab5514ed5827d5c54415549","status":"active","text":"Renal-replacement therapy was used more often in the hydroxyethyl starch group than in the saline group.","confidence":0.97,"contributors":[{"id":1,"public_id":"12632b8b5f","public_label":"Anonymous (12632b8b5f)","roles":["extraction"],"url":"https://sah.borca.ai/u/12632b8b5f"}],"url":"https://sah.borca.ai/claims/cl_9a947649dab5514ed5827d5c54415549"},{"public_id":"cl_3dc606302a72777a6619c74e8b7208d1","status":"active","text":"There was no significant difference in 90-day mortality between ICU patients resuscitated with 6% hydroxyethyl starch 130/0.4 and those resuscitated with saline.","confidence":0.99,"contributors":[{"id":1,"public_id":"12632b8b5f","public_label":"Anonymous (12632b8b5f)","roles":["extraction"],"url":"https://sah.borca.ai/u/12632b8b5f"}],"url":"https://sah.borca.ai/claims/cl_3dc606302a72777a6619c74e8b7208d1"}],"concepts":[{"public_id":"co_23069fbe602cb8651f41fb2678d9c8ca","status":"active","name":"90-day mortality","description":"Death from any cause within 90 days after randomization.","types":["outcome"],"aliases":["death within 90 days"],"contributors":[{"id":1,"public_id":"12632b8b5f","public_label":"Anonymous (12632b8b5f)","roles":["extraction"],"url":"https://sah.borca.ai/u/12632b8b5f"}],"url":"https://sah.borca.ai/concepts/co_23069fbe602cb8651f41fb2678d9c8ca"},{"public_id":"co_4bc5201541fc4bf8cc85fd8262338272","status":"active","name":"hydroxyethyl starch 130/0.4","description":"A 6% hydroxyethyl starch solution with molecular weight 130 kD and molar substitution ratio 0.4 used for fluid resuscitation.","types":["intervention","fluid"],"aliases":["HES","Voluven","6% 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