Existing trial data do not support that hydroxyethyl starch is less harmful when given on more ‘correct’ indications

Meybohm and colleagues hypothesise that so-called ‘correct’ administration of hydroxyethyl starch (HES) may be beneficial and may provide new guidelines for clinical use of HES, but this is not supported by trial data [1]. In contrast, subgrouping trials according to ‘presumable correct indication’ does not change the mortality estimate (see Figure 1). There is also very little statistical heterogeneity (I) in the recent high-quality meta-analyses on HES indicating harmful effects independent of heterogeneity in trial design. Several misinterpretations of the Scandinavian Starch for Severe Sepsis/Septic Shock trial publication [2] need correction. First, the exact dose of trial fluid was accounted for in 8,619 of 8,621 (99.98%) trial patient-days. The lack of fluid data after day 3 is thus due to early death or discharge from the ICU.