Markers of endothelial damage and coagulation impairment in patients with severe sepsis resuscitated with hydroxyethyl starch 130/0.42 vs Ringer acetate

Journal of Critical Care
Rasmus Beier MüllerPär Ingemar Johansson

Abstract

The Scandinavian Starch for Severe Sepsis/Septic Shock (6S) trial showed increased mortality in patients resuscitated with hydroxyethyl starch 130/0.42 (HES) vs Ringer acetate. Different effects of the fluids on the endothelium may have contributed to the observed outcome. We aimed to investigate associations between HES vs Ringer and changes in plasma biomarkers reflecting endothelial damage and coagulation impairment. Six biomarkers, including soluble thrombomodulin (sTM) and plasminogen activator inhibitor 1 (PAI-1), were assessed in a subgroup of 208 patients from the 6S trial. We analyzed differences in plasma concentration in the 2 intervention groups using linear or logistic regression models. The increase in plasma sTM was lower in the HES group (-1.8 ng/mL; 95% confidence interval, -2.9 to -0.7; P = .002). The change was not statistically significant associated with mortality whereas increase in plasminogen activator inhibitor 1 was (odds ratio for 1-unit increase, 1.04; 95% confidence interval, 1.01-1.08; P = .01). Resuscitation with HES vs Ringer decreased early endothelial damage. Although this finding should be interpreted with caution, it indicates that the increased mortality observed with HES in the 6S trial may...Continue Reading

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Citations

Aug 4, 2018·The Cochrane Database of Systematic Reviews·Sharon R LewisIan Roberts
Mar 10, 2019·Critical Care : the Official Journal of the Critical Care Forum·Elissa M Milford, Michael C Reade
Aug 30, 2019·Journal of Clinical Medicine·Kazumasa OdaShinji Ogura
Feb 5, 2019·Frontiers in Veterinary Science·Katja-Nicole Adamik, Ivayla D Yozova
Jan 3, 2021·International Journal of Hematology·Toshiaki IbaJerrold H Levy
Nov 14, 2020·Anesthesia and Analgesia·Nicole P JuffermansDerek J B Kleinveld
Jun 1, 2021·Frontiers in Veterinary Science·Edward S Cooper, Deborah C Silverstein
Oct 5, 2021·Expert Opinion on Therapeutic Targets·Jean-Louis VincentPeter Pickkers

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