ReviewIntensive care medicine2012
Systematic analysis of hydroxyethyl starch (HES) reviews: proliferation of low-quality reviews overwhelms the results of well-performed meta-analyses.
Review in Intensive care medicine, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
16 citing papers in PubMed, 4 syntheses or guidelines pooled it, 43 citations in OpenAlex.
- Association between conflicts of interest and favourable recommendations in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews: systematic review.BMJ (Clinical research ed.) · 2020Pooled it
- Conflicts of interest in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews: associations with recommendations.The Cochrane database of systematic reviews · 2020Pooled it
- Financial conflicts of interest in systematic reviews: associations with results, conclusions, and methodological quality.The Cochrane database of systematic reviews · 2019Pooled it
- Randomised trials of 6% tetrastarch (hydroxyethyl starch 130/0.4 or 0.42) for severe sepsis reporting mortality: systematic review and meta-analysis.Intensive care medicine · 2013Pooled it
- Narrative reviews from a fraudulent author: reasons to retract.Intensive care medicine · 2019Article
- Understanding the Harms of HES: A Review of the Evidence to Date.Turkish journal of anaesthesiology and reanimation · 2019Review
- Competing and conflicting interests in the care of critically ill patients.Intensive care medicine · 2018Review
- Acute kidney injury in critically burned patients treated with hydroxyethyl starch: a response to Sánchez-Sánchez et al.Annals of burns and fire disasters · 2017Article
- Resuscitation with polymeric plasma substitutes is permissive for systemic inflammatory response syndrome and sepsis in multiply injured patients: a retrospective cohort study.European journal of medical research · 2016Article
- The Mass Production of Redundant, Misleading, and Conflicted Systematic Reviews and Meta-analyses.The Milbank quarterly · 2016Article
- Effect of hydroxyethyl starch on blood glucose levels.Korean journal of anesthesiology · 2016Article
- Concerns over use of hydroxyethyl starch solutions.BMJ (Clinical research ed.) · 2014Article
- Reporting bias in trials of volume resuscitation with hydroxyethyl starch.Wiener klinische Wochenschrift · 2014Review
- Controversies in fluid therapy: Type, dose and toxicity.World journal of critical care medicine · 2014Review
- Sepsis: multiple abnormalities, heterogeneous responses, and evolving understanding.Physiological reviews · 2013Article
- Year in review in Intensive Care Medicine 2012. II: Pneumonia and infection, sepsis, coagulation, hemodynamics, cardiovascular and microcirculation, critical care organization, imaging, ethics and legal issues.Intensive care medicine · 2013Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 3 institutions in 2 countries.
Funding
Abstract
purposeHydroxyethyl starch (HES) is a synthetic colloid used widely for resuscitation despite the availability of safer, less costly fluids. Numerous HES reviews have been published that may have influenced clinicians' practice. We have therefore examined the relationship between the methodological quality of published HES reviews, authors' potential conflicts of interest (pCOI) and the recommendations made.
methodsSystematic analysis of reviews on HES use.
resultsBetween 1975 and 2010, 165 reviews were published containing recommendations for or against HES use. From the 1990s onwards, favorable reviews increased from two to eight per year and HES's share of the artificial colloid market tripled from 20 to 60 %. Only 7 % (12/165) of these reviews of HES use contained meta-analyses; these 7 % had higher Overview Quality Assessment Questionnaire (OQAQ) scores [median (range) 6.5 (3-7)] than reviews without meta-analysis [2 (1-4); p < 0.001]. The rates of recommending against HES use are 83 % (10/12) in meta-analyses and 20 % (31/153) in reviews without meta-analysis (p < 0.0001). Fourteen authors published the majority (70/124) of positive reviews, and ten of these 14 had or have since developed a pCOI with various manufacturers of HES.
conclusionsLow-quality HES reviews reached different conclusions than high-quality meta-analyses from independent entities, such as Cochrane Reviews. The majority of these low-quality positive HES reviews were written by a small group of authors, most of whom had or have since established ties to industry. The proliferation of positive HES reviews has been associated with increased utilization of an expensive therapy despite the lack of evidence for meaningful clinical benefit and increased risks. Clinicians need to be more informed that marketing efforts are potentially influencing scientific literature.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.