TY - JOUR
T1 - Are omega-3 fatty acids safe and effective in acute pancreatitis or sepsis?
T2 - A systematic review and meta-analysis
AU - Wolbrink, Daniel R J
AU - Grundsell, Jessica R
AU - Witteman, Ben
AU - Poll, Marcel van de
AU - Santvoort, Hjalmar C van
AU - Issa, Eyad
AU - Dennison, Ashley
AU - Goor, Harry van
AU - Besselink, Marc G
AU - Bouwense, Stefan A W
AU - Dutch Pancreatitis Study Group
N1 - Copyright © 2019 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
PY - 2020/9
Y1 - 2020/9
N2 - BACKGROUND: Acute pancreatitis (AP) is marked by a strong pro-inflammatory response, which may cause a systemic inflammatory response syndrome (SIRS), organ failure, and death. Early administration of omega-3 fatty acids (FA) may reduce the pro-inflammatory response and improve outcome in AP. A systematic review focusing on the safety and efficacy of omega-3 FA in AP is lacking.AIM: Evaluate the safety and efficacy of an intervention with omega-3 FA in acute pancreatitis and additionally in sepsis.METHODS: A systematic review and meta-analysis was performed using the PubMed, Embase, and Cochrane databases including only randomized controlled trials in AP and, for safety endpoints, in sepsis investigating intervention including omega-3 FA without other active components (e.g. addition of glutamine to the intervention). The primary outcome was mortality.RESULTS: After screening 1186 studies, five randomized trials (n = 229) with omega-3 FA in AP were included. In AP patients treated with omega-3 FA within 48 h after hospitalization, a non-significant reduction of mortality was seen (OR 0∙50, 95%CI 0∙13-1∙99, p = 0∙33), compared to controls. In two studies (n = 85), omega-3 FA reduced the risk of new onset of organ failure (OR 0∙33, 95%CI 0∙12-0∙93, p = 0∙04). Nine randomized trials with 312 patients suffering from sepsis (not pancreatitis related) demonstrated a reduced mortality (OR 0∙52, 95%CI 0∙28-0∙97, p = 0·04). None of these 14 randomized trials reported safety concerns.CONCLUSIONS: Administration of omega-3 FA could reduce the risk of new-organ failure in patients with AP. There were no safety issues reported of the early administration of omega-3 FA in any of the included studies. To show the real clinical benefit of omega-3 FA in AP, a large and pragmatic randomized controlled trial is needed.
AB - BACKGROUND: Acute pancreatitis (AP) is marked by a strong pro-inflammatory response, which may cause a systemic inflammatory response syndrome (SIRS), organ failure, and death. Early administration of omega-3 fatty acids (FA) may reduce the pro-inflammatory response and improve outcome in AP. A systematic review focusing on the safety and efficacy of omega-3 FA in AP is lacking.AIM: Evaluate the safety and efficacy of an intervention with omega-3 FA in acute pancreatitis and additionally in sepsis.METHODS: A systematic review and meta-analysis was performed using the PubMed, Embase, and Cochrane databases including only randomized controlled trials in AP and, for safety endpoints, in sepsis investigating intervention including omega-3 FA without other active components (e.g. addition of glutamine to the intervention). The primary outcome was mortality.RESULTS: After screening 1186 studies, five randomized trials (n = 229) with omega-3 FA in AP were included. In AP patients treated with omega-3 FA within 48 h after hospitalization, a non-significant reduction of mortality was seen (OR 0∙50, 95%CI 0∙13-1∙99, p = 0∙33), compared to controls. In two studies (n = 85), omega-3 FA reduced the risk of new onset of organ failure (OR 0∙33, 95%CI 0∙12-0∙93, p = 0∙04). Nine randomized trials with 312 patients suffering from sepsis (not pancreatitis related) demonstrated a reduced mortality (OR 0∙52, 95%CI 0∙28-0∙97, p = 0·04). None of these 14 randomized trials reported safety concerns.CONCLUSIONS: Administration of omega-3 FA could reduce the risk of new-organ failure in patients with AP. There were no safety issues reported of the early administration of omega-3 FA in any of the included studies. To show the real clinical benefit of omega-3 FA in AP, a large and pragmatic randomized controlled trial is needed.
KW - Acute pancreatitis
KW - Anti-inflammatory
KW - CONTROLLED-TRIAL
KW - CRITICALLY-ILL PATIENTS
KW - DOUBLE-BLIND
KW - FISH-OIL
KW - IMPACT
KW - INFLAMMATION
KW - LIPID EMULSION
KW - MANAGEMENT
KW - N-3 FATTY-ACIDS
KW - Omega-3 fattyacids
KW - Organ failure
KW - PARENTERAL-NUTRITION
KW - Safety
KW - Sepsis
KW - MORTALITY
U2 - 10.1016/j.clnu.2019.12.006
DO - 10.1016/j.clnu.2019.12.006
M3 - (Systematic) Review article
C2 - 31959476
SN - 0261-5614
VL - 39
SP - 2686
EP - 2694
JO - Clinical Nutrition
JF - Clinical Nutrition
IS - 9
ER -