Please select the eligibility criteria that correspond to the clinical trial below.
Title: Effects of Hydroxyethyl Starch 130/0.4 Compared With Balanced Crystalloid Solution on Mortality and Kidney Failure in Patients With Severe Sepsis
Brief Summary: * By tradition hydroxyethyl starch (HES) is used to obtain fast circulatory stabilisation in critically ill.
* High molecular weight HES may, however, cause acute kidney failure in patients with severe sepsis.
* Now the low molecular weight HES 130/0.4 is the preferred colloid in Scandinavian intensive care units (ICU) and 1st choice fluid for patients with severe sepsis.
* HES 130/0.4 is largely unstudied in ICU patients.
* This investigator-initiated Scandinavian multicentre trial will be conducted to assess the effects of HES 130/0.4 on mortality and endstage kidney failure in patients with severe sepsis.
* The trial will provide important data to all clinicians who resuscitate septic patients.


Options:
A: Inclusion Criteria:

* Patients with cirrhosis in the waiting list for liver transplant
* Patients with ascites or diuretic treatment
* To have written inform consent

Exclusion Criteria:

* Systolic blood pressure ≥150 mmHg and or diastolic blood pressure≥90 mmHg
* To have been treated with transjugular intrahepatic portosystemic shunt (TIPS) or surgical shunts
* Antibiotic treatment in the previous week before the inclusion in the study
* Respiratory or cardiac failure
* HIV positive
B: Inclusion Criteria:

* Cirrhosis and ascites submitted to paracentesis \> 5 liters
* Age: 18-75 years
* Informed written consent

Exclusion Criteria:

* Multinodular HCC (\> 3 nodules)
* Portal vein thrombosis
* Ongoing bacterial infection
* Ongoing or recent (less than one week) bleeding
* Cardio-pulmonary failure
* Hepatorenal syndrome type 1
* Severe coagulopathy: platelets \< 30.000/mm3 and/or PT \< 30%
* Ongoing treatment with vasoactive drugs
C: Inclusion Criteria:

* Age between 18 and 75 years;
* Cirrhosis defined by clinical, analytical or histological criteria;
* Active infection defined by the presence of at least two of the criteria for systemic inflammatory response syndrome (SIRS), necessarily including neutrophilia in the hemogram. In case of a positive culture, the presence of only one of the SIRS criteria is considered sufficient for the infection diagnosis. SIRS is defined by: temperature \>38º or \<36º C, heart beat \>90 beats/min, breath frequency \>20 resp/min, white cell count \>12000/mm3 or \<4000/mm3 or \>6% of immature cells.
* Written informed consent.
* Absence of the exclusion criteria described below

Exclusion Criteria:

* Use of antibiotics during the week preceding the study, except for prophylaxis of spontaneous bacterial peritonitis;
* Hepatocarcinoma: hepatocarcinoma patients presenting more than 3 nodes \> 3 cm, or one node larger than 5 cm, tumoral portal thrombosis or extrahepatic tumor extension;
* Heart insufficiency or advanced chronic obstructive pulmonary disease;
* Digestive bleeding during the week preceding the study;
* Presence of septic shock, defined as: sepsis with hypotension (systolic pressure \<90 mm Hg or a decrease \>40 mm Hg as compared to the basal pressure), in spite of an adequate liquid reposition, signs of a poor peripheral perfusion or need of vasoactive drugs;
* Plasma creatinine \> 3 mg/dL;
* Severe dehydration (defined by a central venous pressure \< 3 cm H2O due to severe diarrhea or to a strong response to diuretic treatment) at inclusion in the study; the patients with PVC lower than 3 will receive plasma volume expansion with saline and will be reevaluated within 24 h. If the expansion is able to correct PVC (defined as PVC \> 3), the patients will be apt to be included in the study.
* Existence of diseases which can influence the short term survival.
D: Inclusion Criteria:

All adult patients who

* Undergo resuscitation in the ICU
* AND fulfillment within the previous 24 hours of the criteria for severe sepsis (SCCM/ACCP)
* AND consent is obtainable either from the patient or by proxy (physician and/or next of kin)

Exclusion Criteria:

The following patients will not be evaluated for inclusion:

* Age \< 18 years old
* Previously randomised in the 6S trial
* Allergy towards hydroxyethyl starch or malic acid
* Treatment with \> 1000 ml's of any synthetic colloid within the last 24 hours prior to randomisation
* Any form of renal replacement therapy
* Acute burn injury \> 10% body surface area
* Severe hyperkalaemia, p-K \> 6 mM
* Liver or kidney transplantation during current hospital admission
* Intracranial bleeding within current hospitalisation
* Enrollment into another ICU trial of drugs with potential action on circulation, renal function or coagulation
* Withdrawal of active therapy

Answer: D