Fifty-nine trials were included in the review (4,529 patients): 2,139 patients were treated with tetrastarch and 2,390 were treated with comparator solutions.
Mortality (21 trials): Mortality was statistically significantly higher among comparator groups compared with groups which received tetrastarches (OR 0.51, 95% CI 0.24 to 1.05; 21 trials).
Coagulation (50 trials): In comparison with other treatments, the use of a tetrastarch was not associated with increased perioperative blood loss, an increase in allogeneic blood volume transfused, or exposure to allogeneic blood products when compared with other colloids or crystalloids. In the two trials on trauma patients, results were mixed (reported fully in the review).
Renal replacement therapy (seven trials): Patients receiving tetra-starch treatment had lower rates of renal replacement therapy then comparator groups; this difference was not statistically significant.
Creatinine (21 trials): All but three trials demonstrated no differences between groups in peak creatinine concentrations or nadir creatinine clearances during the postoperative period. The remaining three trials showed statistically significant benefit with the use of tetrastarch (two trials), or a lower creatinine concentration with a crystalloid comparator (one trial).
Urine output (35 trials): No statistically significant differences were observed between the tetrastarch and comparator groups.