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Administering immune nutrients through parenteral means to patients with severe acute pancreatitis results in reduced mortality, infection rates, length of hospital stay, and length of intensive care unit stay, along with the downregulation of inflammatory markers.
In a recent network meta-analysis, parenteral glutamine ranked best in reducing infections in patients with acute pancreatitis. On the other hand, parenteral omega-3 polyunsaturated fatty acids ranked best in curtailing mortality, length of hospital stay (LOH), and length of intensive care unit stay (LOI), as well as in the downregulation of C-reactive protein (CRP). Researchers sought to assess the impact of various immune nutrients in the treatment of acute pancreatitis.
Scopus, Web of Science, Cochrane Library, Embase, and PubMed were employed to conduct a comprehensive search for randomized controlled trials. The focus of the investigation was on individuals grappling with pancreatitis and the various intervention methodologies applied, such as the administration of nucleotides, glutamine, arginine, and omega-3 polyunsaturated fatty acids. The assessed outcomes encompassed levels of CRP, LOI, LOH, incidences of infection, and mortality rates.
Utilizing a network meta-analysis random-effects model, the risk ratio and mean difference (MD) were computed. The surface under the cumulative ranking curve (SUCRA) was utilized to establish the relative ranking of interventions. Utilizing the Cochrane Risk of Bias tool 2, the assessment of the risk of bias was conducted. Sources of heterogeneity were explored via network meta-regression and sensitivity analysis. The credibility of the evidence was gauged with the utilization of the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE).
Overall, 19 studies were encompassed with a total of 1035 volunteers. As found, parenteral glutamine demonstrated superior effectiveness in lowering the downregulation of CRP, LOI, LOH, infection, and mortality in comparison with the control. The calculated risk ratio or MD values were -17.78, -2.53, -3.32, 0.35, and 0.38, respectively. Additionally, parenteral omega-3 polyunsaturated fatty acids exhibited greater efficacy in lowering CRP levels, LOI, and LOH, with MD values of -26.20, -5.19, and -6.77, respectively.
Other immune nutrients in the comparison groups did not manifest any discernible impact when compared to the control across all the evaluated outcomes. Notably, parenteral glutamine ranked best in alleviating infections, while parenteral omega-3 polyunsaturated fatty acids took the lead in reducing mortality, LOH, LOI, and CRP downregulation. Hence, patients suffering from acute pancreatitis may derive benefits from certain immune nutrients. Opting for parenteral administration might prove more advantageous than enteral administration.
Medicine (Baltimore)
Efficacy of immune nutrients in severe acute pancreatitis: A network meta-analysis
Xin Tao et al.
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