As of this writing I have only had five different play throughs on the following race/classes:
During these five play throughs I always get the same option with Astarion when he asks for assistance. The first is essentially saying I can kill the creature he is talking about, while the second says something along the lines of "do it yourself."
Each option ends up with him coming at you with a knife. There are additional options that are afforded to the player based on class, stats etc, but my main complaint is that at least on my play throughs, it starts immediately with a knife and then changes.
Why is that a problem? You are a complete stranger that, for all he knows, is part of how he ended up in the position he's in. Shadowheart is no less hostile immediately upon coming up on her, she just doesn't draw a knife, and she mellows, a bit, if you tried to save her on the ship. I don't know what happens if you don't try, because I always try, just to spite Lae'Zel. In his case, however, it's far more disturbing to him, because he's standing there in broad daylight, and he's not on fire.