Effects of fish oil-containing nutrition supplementation in adult sepsis patients: a systematic review and meta-analysis

Hongyu Wang; Sen Su; Chao Wang; Jianhong Hu; Wu Dan; Xi Peng

doi:10.1093/burnst/tkac012

您当前的位置：

首页 >

文章列表页 >

Effects of fish oil-containing nutrition supplementation in adult sepsis patients: a systematic review and meta-analysis

更新时间：2023-09-05

- Effects of fish oil-containing nutrition supplementation in adult sepsis patients: a systematic review and meta-analysis
- Burns & Trauma Vol. 10, Issue 1, (2022)
- 作者机构：
  
  1. Clinical Medical Research Center, Southwest Hospital, The Third Military Medical University
  2. Department of Burns and Plastic, PLA No. Hospital,983
  3. Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, The Third Military Medical University
- 作者简介：
- 基金信息：
- DOI：10.1093/burnst/tkac012
  CLC：
- Published：2022，
  
  Published Online：10 June 2022，
扫描看全文
Hongyu Wang, Sen Su, Chao Wang, Jianhong Hu, Wu Dan, Xi Peng, Effects of fish oil-containing nutrition supplementation in adult sepsis patients: a systematic review and meta-analysis, Burns & Trauma, Volume 10, 2022, tkac012, https://doi.org/10.1093/burnst/tkac012
DOI：

Hongyu Wang, Sen Su, Chao Wang, Jianhong Hu, Wu Dan, Xi Peng, Effects of fish oil-containing nutrition supplementation in adult sepsis patients: a systematic review and meta-analysis, Burns & Trauma, Volume 10, 2022, tkac012, https://doi.org/10.1093/burnst/tkac012 DOI：

摘要

Abstract

BackgroundSepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection. Although fish oil has been used as an immunonutritional preparations for the treatment of sepsis patients

there is still controversy as to whether it is beneficial to them. We systematically reviewed published clinical trial data to evaluate the effectiveness of fish oil-containing nutrition supplementation in sepsis patients.MethodsA systematic search was undertaken in PubMed

Embase

Chinese Biomedicine Database

the Cochrane Library and the China Knowledge Resource Integrated Database to obtain clinical controlled trails. RCTs on nutrition therapy containing fish oil among adult sepsis patients were selected for analysis in comparison with routine therapy.ResultsTwenty-five published trials were included in the meta-analysis. Fish oil-containing nutrition supplementation reduced the mortality compared with the control group (relative risk (RR) 0.74

I2 = 0%). Fish oil also shortened the ICU stay (MD −3.57 days; 95% CI −4.54

−2.59; p<0.00001; I2 = 76%)

hospital stay (MD −9.92 days; 95% CI −15.37

−4.46; p = 0.0004; I2 = 91%) and the duration of mechanical ventilation support (MD −2.26; 95% CI −4.27

−0.26; p = 0.03; I2 = 83%). A subgroup analysis based on the route of administration revealed that parenteral administration of fish oil could reduce mortality in septic patients (RR =0.68

I2 = 0%)

but no significant difference in mortality was observed in the fish oil group administered by enteral route (RR = 0.80

I2 = 0%). No statistically significant publication biases were detected for the above clinical endpoints (p>0.05).ConclusionsParenteral nutrition containing fish oil could significantly decrease mortality in sepsis patients while enteral administration could not. Fish oil-containing nutrition supplementation.

关键词

Keywords

SepsisFish oilMeta-analysisNutrition therapyOmega-3 fatty acids

references

1.Levy MM, Evans LE, Rhodes A. The surviving sepsis campaign bundle: 2018 update. Intensive Care Med. 2018;44:925–8.

2.Fernando SM, Rochwerg B, Seely AJE. Clinical implications of the third international consensus definitions for sepsis and septic shock (Sepsis-3). CMAJ. 2018;190:E1058–e1059.

3.Schenck EJ, Ma KC, Murthy SB, Choi AMK. Danger signals in the ICU. Crit Care Med. 2018;46:791–8.

4.Cecconi M, Evans L, Levy M, Rhodes A. Sepsis and septic shock. Lancet. 2018;392:75–87.

6.Zhang P, Zou B, Liou YC, Huang C. The pathogenesis and diagnosis of sepsis post burn injury. Burns Trauma. 2021;9:tkaa047.

7.van Niekerk G, Meaker C, Engelbrecht AM. Nutritional support in sepsis: when less may be more. Crit Care. 2020;24:53.

8.Opal SM, Wittebole X. Biomarkers of infection and sepsis. Crit Care Clin. 2020;36:11–22.

9.Fragkos KC, Sebepos-Rogers G, Rahman F. When is parenteral nutrition indicated in the hospitalized, acutely ill patient? Curr Opin Gastroenterol. 2020;36:129–35.

10.Bowman L, Mafham M, Wallendszus K, Stevens W, Buck G, Barton J, et al. Effects of n-3 fatty acid supplements in diabetes mellitus. N Engl J Med. 2018;379:1540–50.

11.Christmann U, Hancock CL, Poole CM, Emery AL, Poovey JR, Hagg C, et al. Dynamics of DHA and EPA supplementation: incorporation into equine plasma, synovial fluid, and surfactant glycerophosphocholines. Metabolomics. 2021;17:41.

12.Nicholls SJ, Lincoff AM, Garcia M, Bash D, Ballantyne CM, Barter PJ, et al. Effect of high-dose Omega-3 fatty acids vs corn oil on major adverse cardiovascular events in patients at high cardiovascular risk: the STRENGTH randomized clinical trial. JAMA. 2020;324:2268–80.

13.Fisk HL, Childs CE, Miles EA, Ayres R, Noakes PS, Paras-Chavez C, et al. Dysregulation of endocannabinoid concentrations in human subcutaneous adipose tissue in obesity and modulation by omega-3 polyunsaturated fatty acids. Clin Sci (Lond). 2021;135:185–200.

14.Coghill AE, Schenk JM, Mahkoul Z, Orem J, Phipps W, Casper C. Omega-3 decreases IL-6 levels in HIV and human herpesvirus-8 coinfected patients in Uganda. AIDS. 2018;32:505–12.

15.Morvaridzadeh M, Sepidarkish M, Yavari M, Tahvilian N, Heydarian A, Khazdouz M, et al. The effects of omega-3 fatty acid supplementation on inflammatory factors in HIV-infected patients: A systematic review and meta-analysis of randomized clinical trials. Cytokine. 2020;136:155298.

16.Infante M, Ricordi C, Padilla N, Alvarez A, Linetsky E, Lanzoni G, et al. The role of vitamin D and Omega-3 PUFAs in islet transplantation. Nutrients. 2019;11:2937–1.

17.Chen H, Wang S, Zhao Y, Luo Y, Tong H, Su L. Correlation analysis of omega-3 fatty acids and mortality of sepsis and sepsis-induced ARDS in adults: data from previous randomized controlled trials. Nutr J. 2018;17:57.

18.Mo Y, Hu X, Chang L, Ma P. The effect of ω-3 fatty acid supplementation in parenteral nutrition on the outcome of patients with sepsis: a systematic review and meta-analysis. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2014;26:142–7.

19.Tao W, Li PS, Shen Z, Shu YS, Liu S. Effects of omega-3 fatty acid nutrition on mortality in septic patients: a meta-analysis of randomized controlled trials. BMC Anesthesiol. 2016;16:39.

20.Palmer AJ, Ho CK, Ajibola O, Avenell A. The role of omega-3 fatty acid supplemented parenteral nutrition in critical illness in adults: a systematic review and meta-analysis. Crit Care Med. 2013;41:307–16.

21.Higgins J, Altman DG, Gtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:1.

22.Wong SSWN, Haynes RB. Developing optimal search strategies for detecting clinically sound treatment studies in EMBASE. J Med Libr Assoc. 2006;94:41–7.

23.Haynes RBMK, Wilczynski NL, Walter SD, Werre SR. Hedges team: optimal search strategies for retrieving scientifically strong studies of treatment from Medline: analytical survey. BMJ. 2005;330:1179.

24.Grau-Carmona T, Moran-Garcia V, Garcia-de-Lorenzo A, Heras-de-la-Calle G, Quesada-Bellver B, Lopez-Martinez J, et al. Effect of an enteral diet enriched with eicosapentaenoic acid, gamma-linolenic acid and anti-oxidants on the outcome of mechanically ventilated, critically ill, septic patients. Clin Nutr. 2011;30:578–84.

25.Barbosa VM, Miles EA, Calhau C, Lafuente E, Calder PC. Effects of a fish oil containing lipid emulsion on plasma phospholipid fatty acids, inflammatory markers, and clinical outcomes in septic patients: a randomized, controlled clinical trial. Crit Care. 2010;14:R5.

26.Pontes-Arruda A, Aragao AM, Albuquerque JD. Effects of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in mechanically ventilated patients with severe sepsis and septic shock. Crit Care Med. 2006;34:2325–33.

27.Pontes-Arruda A, Martins LF, de Lima SM, Isola AM, Toledo D, Rezende E, et al. Investigating nutritional therapy with Epa GLA, antioxidants role in sepsis treatment study G: enteral nutrition with eicosapentaenoic acid, gamma-linolenic acid and antioxidants in the early treatment of sepsis: results from a multicenter, prospective, randomized, double-blinded, controlled study: the INTERSEPT study. Crit Care. 2011;15:R144.

28.Qu AJ, Xu L. Immuno-regulation efect of ω-3 fish oil fat emulsion in patients with severe sepsis. Shandong Medicine. 2009;49:13–5.

29.Khor B-S, Liaw S-J, Shih H-C, Wang L-S. Randomized, double blind, placebo-controlled trial of fish-oil-based lipid emulsion infusion for treatment of critically ill patients with severe sepsis. Asian J Surg. 2011;34:1–10.

30.Burkhart CS, Dell-Kuster S, Siegemund M, Pargger H, Marsch S, Strebel SP, et al. Effect of n-3 fatty acids on markers of brain injury and incidence of sepsis-associated delirium in septic patients. Acta Anaesthesiol Scand. 2014;58:689–700.

31.Grecu IML, Grintescu I. Parenteral fish oil supplementation in patients with abdominal sepsis. Clin Nutr. 22:s23.

32.Liu H. The influence of omega 3 fatty acid on the immune function of sepsis. Shandong, China:Master's thesis, Shan Dong University, 2011.

33.Hall TC, Bilku DK, Al-Leswas D, Neal CP, Horst C, Cooke J, et al. A randomized controlled trial investigating the effects of parenteral fish oil on survival outcomes in critically ill patients with sepsis: a pilot study. JPEN J Parenter Enteral Nutr. 2015;39:301–12.

34.Hosny M, Nahas R, Ali S, Elshafei SA, Khaled H. Impact of oral omega-3 fatty acids supplementation in early sepsis on clinical outcome and immunomodulation. The Egyptian Journal of Critical Care Medicine. 2013;1:119–26.

35.Leiderman IMO, Levit A. Omega 3 enriched lipid emulsion decreases APACHE II and SOFA scores values in abdominal sepsis patients. Clin Nutr Suppl. 2010;5:30.

36.Liang X, Fang LZ, Zhang Y. The inhibitory effect of ω-3 fish oil fat emulsion on severe sepsis. China Prac Med. 2009;4:158–9.

37.Shirai K, Yoshida S, Matsumaru N, Toyoda I, Ogura S. Effect of enteral diet enriched with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in patients with sepsis-induced acute respiratory distress syndrome. J Intensive Care. 2015;3:24.

38.Wu YY, He ZY, Xie XH, Xie XH, Zhu Y, Zhou ZY. Omega-3 polyunsaturated fatty acids on immune function and prognosis in patients with sepsis. Guangdong Medical Jouranl. 2011;32:17–2332.

39.Chen HS, Wang W, Zhang HD, Hong CY, Wen XM, Wu SN. Fish oil fat emulsion for the treatment of sepsis and multiple organ dysfunction. Guangdong Medical Journal. 2011;32:24–3271.

40.Chen HS, Wang W, Hong CY, Zhang M, Hong YC, Wang S, et al. Omega-3 fish oil reduces mortality due to severe sepsis with acute gastrointestinal injury grade III. Pharmacogn Mag. 2017;13(51):407–12.

41.Chen H, Wang W, Hong Y, Zhang H, Hong C, Liu X. Single-blinded, randomized, and controlled clinical trial evaluating the effects of Omega-3 fatty acids among septic patients with intestinal dysfunction: A pilot study. Exp Ther Med. 2017;14:1505–11.

42.Chen H, Tong F, Wang X, Gao MY, Liu F, Liu ZK, et al. The protective effect of omega −3 PUFA on patients with sepsis resulting from serious abdominal infection. Chin J Crit Care Med. 2014;34:676–8.

43.Galbán C, Montejo JC, Mesejo A, Marco P, Celaya S, Sánchez-Segura JM, et al. An immune-enhancing enteral diet reduces mortality rate and episodes of bacteremia in septic intensive care unit patients. Crit Care Med. 2000;28:643–8.

44.He T. Effects of omega-3 polyunsaturated fatty acids on inflammatory response and prognosis in patients with sepsis. Chinese Remedies and Clinics. 2018;18:764–5.

45.Zhao KT, Zhang H, Zhang Y, Zhang K, Duan LJ. Omega-3 polyunsaturated fatty acids on ARDS in patients with sepsis. Journal of Shandong Medicine. 2011;51:110–1.

46.Zhao KT, Zhang H, Zhang Y, Zhou WN, Lin J. Effect of fish oil fat milk on antibiotic use in patients with sepsis. Journal of Cheng De Medicine College. 2012;29:148–9.

47.Ibrahim ES. Enteral nutrition with omega-3 fatty acids in critically ill septic patients: A randomized double-blinded study. Saudi J Anaesth. 2018;12:529–34.

48.Hai XG, Hu W, Liu R, Wang YH, Wang J, et al. Effects of ω-3 polyunsaturated fatty acids on immune function and prognosis in patients with sepsis. Chin Med. 2011;6:87–8.

49.Zuccari S, Damiani E, Domizi R, Scorcella C, D'Arezzo M, Carsetti A, et al. Changes in cytokines, Haemodynamics and microcirculation in patients with sepsis/septic shock undergoing continuous renal replacement therapy and blood purification with CytoSorb. Blood Purif. 2020;49:107–13.

50.Chousterman BG, Swirski FK, Weber GF. Cytokine storm and sepsis disease pathogenesis. Semin Immunopathol. 2017;39:517–28.

51.Grondman I, Pirvu A, Riza A, Ioana M, Netea MG. Biomarkers of inflammation and the etiology of sepsis. Biochem Soc Trans. 2020;48:1–14.

52.Hotchkiss RS, Monneret G, Payen D. Sepsis-induced immunosuppression: from cellular dysfunctions to immunotherapy. Nat Rev Immunol. 2013;13:862–74.

53.Cugno C, Kizhakayil D, Calzone R, Rahman SM, Halade GV, Rahman MM. Omega-3 fatty acid-rich fish oil supplementation prevents rosiglitazone-induced osteopenia in aging C57BL/6 mice and in vitro studies. Sci Rep. 2021;11:10364.

54.Dasilva G, Lois S, Mendez L, Miralles-Perez B, Romeu M, Ramos-Romero S, et al. Fish oil improves pathway-oriented profiling of lipid mediators for maintaining metabolic homeostasis in adipose tissue of Prediabetic rats. Front Immunol. 2021;12:608875.

55.Calder PC. Omega-3 fatty acids and inflammatory processes: from molecules to man. Biochem Soc Trans. 2017;45:1105–15.

56.Mas E, Croft KD, Zahra P, Barden A, Mori TA. Resolvins D1, D2, and other mediators of self-limited resolution of inflammation in human blood following n-3 fatty acid supplementation. Clin Chem. 2012;58:1476–84.

57.Mas E, Barden A, Burke V, Beilin LJ, Watts GF, Huang RC, et al. A randomized controlled trial of the effects of n-3 fatty acids on resolvins in chronic kidney disease. Clinical Nutrition. 2016;35(2):331–36.

58.Zaloga GP. Narrative review of n-3 polyunsaturated fatty acid supplementation upon immune functions, resolution molecules and lipid peroxidation. Nutrients. 2021;13:662.

59.Padovan MG, Norling LV. Pro-resolving lipid mediators in sepsis and critical illness. Curr Opin Clin Nutr Metab Care. 2020;23:76–81.

60.Lu C, Sharma S, McIntyre L, Rhodes A, Evans L, Almenawer S, et al. Omega-3 supplementation in patients with sepsis: a systematic review and meta-analysis of randomized trials. Ann Intensive Care. 2017;7:58.

61.Parikh R, Bates JHT, Poynter ME, Suratt BT, Parsons PE, Kien CL, et al. Pharmacokinetics of omega-3 fatty acids in patients with severe sepsis compared with healthy volunteers: A prospective cohort study. Clin Nutr. 2020;39:958–65.

62.Rubio I, Osuchowski MF, Shankar-Hari M, Skirecki T, Winkler MS, Lachmann G, et al. Current gaps in sepsis immunology: new opportunities for translational research. Lancet Infect Dis. 2019;19:e422–36.

63.Reber E, Messerli M, Stanga Z, Mühlebach S. Pharmaceutical aspects of artificial nutrition. J Clin Med. 2019;8(11):8.

64.Wei C, Hua J, Bin C, Klassen K. Impact of lipid emulsion containing fish oil on outcomes of surgical patients: systematic review of randomized controlled trials from Europe and Asia. Nutrition. 2010;26:474–81.

65.Pradelli L, Mayer K, Muscaritoli M, Heller AR. N-3 fatty acid-enriched parenteral nutrition regimens in elective surgical and ICU patients: a meta-analysis. Crit Care. 2012;16:R184.

66.Manzanares W, Langlois PL, Heyland DK. The role of alternative lipid emulsions in critically ill patients: what the evidence shows. JPEN J Parenter Enteral Nutr. 2014;38:653–4.

67.Manzanares W, Dhaliwal R, Jurewitsch B, Stapleton RD, Jeejeebhoy KN, Heyland DK. Parenteral fish oil lipid emulsions in the critically ill: a systematic review and meta-analysis. JPEN J Parenter Enteral Nutr. 2014;38:20–8.

68.Lekka ME, Liokatis S, Nathanail C, Galani V, Nakos G. The impact of intravenous fat emulsion administration in acute lung injury. Am J Respir Crit Care Med. 2004;169:638–44.

69.Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM consensus conference committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101:1644–55.

查看原文

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Combination therapy of thiamine, vitamin C and hydrocortisone in treating patients with sepsis and septic shock: a meta-analysis and trial sequential analysis

Matrix metalloproteinase-8 regulates dendritic cell tolerance in late polymicrobial sepsis via the nuclear factor kappa-B p65/β-catenin pathway

The m6A reader YTHDF2 alleviates the inflammatory response by inhibiting IL-6R/JAK2/STAT1 pathway-mediated high-mobility group box-1 release

p53 promotes the expansion of regulatory T cells via DNMT3a- and TET2- mediated Foxp3 expression in sepsis

Related Author

Renqi Yao

Yibing Zhu

Yue Yu

Zhixuan Li

Lixue Wang

Liyu Zheng

Jingyan Li

Huibin Huang

Related Institution

Department of Burn Surgery

Research Unit of key techniques for treatment of burns and combined burns and trauma injury

Medical Research and Biometrics Center

Department of Cardiothoracic Surgery

International Cooperation Laboratory on Signal Transduction

⁰