Efficacy of probiotics or synbiotics for critically ill adult patients: a systematic review and meta-analysis of randomized controlled trials

Kai Wang; Qin Zeng; Ke-xun Li; Yu Wang; Lu Wang; Ming-wei Sun; Jun Zeng; Hua Jiang

doi:10.1093/burnst/tkac004

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Efficacy of probiotics or synbiotics for critically ill adult patients: a systematic review and meta-analysis of randomized controlled trials

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- Efficacy of probiotics or synbiotics for critically ill adult patients: a systematic review and meta-analysis of randomized controlled trials
- Efficacy of probiotics or synbiotics for critically ill adult patients: a systematic review and meta-analysis of randomized controlled trials
- Burns & Trauma 2022年10卷第1期
- 作者机构：
  
  1. University of Electronic Science and Technology of China
  2. Sichuan Provincial Maternity and Child Health Care Hospital, The Affiliated Women’s and children’s Hospital of Chengdu Medical College
- 作者简介：
- 基金信息：
  
  This work was supported by grants from the Sichuan Provincial Department of Science and Technology (No. 2020YFS0006 to HJ and No. 2018JY0050 to QZ), National Natural Science Foundation of China (No. 71974200 to HJ), Sichuan Provincial People's Hospital (No. 2021ZX01 to KW), Health Commission of Sichuan Province (No. 20PJ102 to KW), and Education Department of Sichuan Province (No. 18ZA0155). Funders played no role in the study design, conduct or manuscript writing.
- DOI：10.1093/burnst/tkac004
  中图分类号：
- 纸质出版日期：2022，
  
  网络出版日期：2022-3-14，
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Efficacy of probiotics or synbiotics for critically ill adult patients: a systematic review and meta-analysis of randomized controlled trials[J]. Burns & Trauma, 2022,10(1).

Kai Wang, Qin Zeng, Ke-xun Li, Yu Wang, Lu Wang, Ming-wei Sun, Jun Zeng, Hua Jiang, Efficacy of probiotics or synbiotics for critically ill adult patients: a systematic review and meta-analysis of randomized controlled trials, Burns & Trauma, Volume 10, 2022, tkac004, https://doi.org/10.1093/burnst/tkac004
Efficacy of probiotics or synbiotics for critically ill adult patients: a systematic review and meta-analysis of randomized controlled trials[J]. Burns & Trauma, 2022,10(1). DOI： 10.1093/burnst/tkac004.

Kai Wang, Qin Zeng, Ke-xun Li, Yu Wang, Lu Wang, Ming-wei Sun, Jun Zeng, Hua Jiang, Efficacy of probiotics or synbiotics for critically ill adult patients: a systematic review and meta-analysis of randomized controlled trials, Burns & Trauma, Volume 10, 2022, tkac004, https://doi.org/10.1093/burnst/tkac004 DOI：

摘要

Abstract

BackgroundMicrobial dysbiosis in critically ill patients is a leading cause of mortality and septic complications. Probiotics and synbiotics have emerged as novel therapy on gut microbiota to prevent septic complications. However

current evidence on their effects is conflicting. This work aims to systematically review the impact of probiotics or synbiotics in critically ill adult patients.MethodsA comprehensive search of the PubMed

CBM

Embase

CENTRAL

ISI

and CNKI databases was performed to identify randomized controlled trials that evaluate probiotics or synbiotics in critically ill patients. The quality assessment was based on the modified Jadad's score scale and the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1. The major outcome measure was mortality. Secondary outcomes included incidence of septic complications

sepsis incidence

length of intensive care unit (ICU) stay

incidence of non-septic complication

and ventilator day. Data synthesis was conduct by Review Manager 5.4.ResultsA total of 25 randomized controlled trials reporting on 5049 critically ill patients were included. In the intervention group

2520 participants received probiotics or synbiotics

whereas 2529 participants received standard care or placebo. Pooling data from randomized controlled trials demonstrated a significant reduction in the incidence of ventilator-associated pneumonia (VAP) in the treatment group [(risk ratio (RR) 0.86; 95% confidence interval (CI): 0.78–0.95; p < 0.003

I2 = 85%)]. However

in the subgroup analysis

the reduction of incidence of VAP was only significant in patients receiving synbiotics (RR = 0.61

95% CI: 0.47–0.80

p = 0.0004

I2 = 40%) and not significant in those receiving only probiotics (RR = 0.91

95% CI: 0.82–1.01

p = 0.07

I2 = 65%). Moreover

sepsis incidence of critically ill patients was only significantly reduced by the addition of synbiotics (RR = 0.41; 95% CI: 0.22–0.72

p = 0.005

I2 = 0%). The incidence of ICU-acquired infections was significantly reduced by the synbiotics therapy (RR = 0.72; 95% CI: 0.58–0.89

p = 0.0007

I2 = 79%). There was no significant difference in mortality

diarrhea

or length of ICU stay between the treatment and control groups.ConclusionsSynbiotics is an effective and safe nutrition therapy in reducing septic complications in critically ill patients. However

in such patients

administration of probiotics alone compared with placebo resulted in no difference in the septic complications.

关键词

Keywords

Critically ill patientsProbioticsSynbioticsMeta-analysisSystematic reviewMortalityVentilator-associated pneumonia

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