Efficacy of Fish Oil Containing Lipid Emulsion in Sepsis: A Meta-Analysis_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

Department of Nutriology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510120, China;

Corresponding author：

Keywords：

Sepsis; Fish oil; Omega-3 fatty acids; Emulsions; Meta-analysis

DOI：

10.7507/1671-6205.2014040

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Objective To evaluate the clinical efficacy of fish oil containing lipid emulsion (FO) in sepsis. Methods Randomized controlled trials about fish oil containing lipid emulsion in sepsis,which were published from 1980,were searched from the following electronic databases:PubMed,Embase,Foreign Medical Journal Service,Cochrane Library,CNKI,Wanfang Database,and VIP Database. The articles screening,quality assessment and data extraction were conducted by two reviewers independently. The methodological quality of trials was assessed by Jadad's scale. All data was analyzed by Review Manager 5.2 software. Results Fifteen studies involving 794 participants met the inclusion criteria. The meta-analysis results were as follows:compared with the control group,①FO could shorten the length of ICU stay[WMD=-5.59,95%CI(-7.65,-3.53)] and the length of hospital stay[WMD=-10.48,95%CI(-14.67,-6.29)],and also decrease the 28-day mortality[RR=0.69,95%CI(0.52,0.93)]. ②FO could reduce the concentration of TNF-α[WMD=31.78,95%CI(5.63,57.92)] and improve oxygenation index[WMD=41.95,95%CI(30.80,53.11)] in septic patients. ③There was no statistical significance in the decrease of C-reactive protein (CRP) between two groups(P>0.05). Conclusion The administration of FO in septic patients can significantly shorten the length of ICU stay and hospital stay,decrease the 28-day mortality,reduce the concentration of TNF-α and improve oxygenation index. However,it shows no significant difference in the decrease of CRP compared with the administration of traditional lipid emulsion. All of the above results show that the septic patients can benefit from the administration of fish oil containing lipid emulsion.

Citation： Lin Tingting, Jiang Mei, Huang Yongbo, Mao Pu, Liu Xiaoqing, Yan Feng, Zhang Rong, Li Yimin. Efficacy of Fish Oil Containing Lipid Emulsion in Sepsis: A Meta-Analysis. Chinese Journal of Respiratory and Critical Care Medicine, 2013, 12(2): 162-169. doi: 10.7507/1671-6205.2014040 Copy

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2.	Heller AR,Rossler S,Litz RJ,et al.Omega-3 fatty acids improve the diagnosis-related clinical outcome.Critical care medicine,2006,34: 972-979.
3.	Bone RC,Balk RA,Cerra FB,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.1992.Chest,2009,136(5 Suppl): e28.
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5.	赵凯峰,张弘,张颖,等.早期静脉应用ω-3鱼油脂肪乳对脓毒症所致ARDS的临床疗效观察.山东医药,2011,51:110-111.
6.	曲爱君,徐珞.鱼油脂肪乳对脓毒症患者免疫功能的调节作用观察.山东医药,2009,49:13-15.
7.	赵凯峰,张弘,张坤,等.ω-3鱼油脂肪乳对脓毒症患者抗生素使用的影响,承德医学院学报,2012,29:148-149.
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11.	黄志平.鱼油治疗感染性休克的临床疗效观察.Strait Pharmaceutical Journal,2011, 23: 99-101.
12.	熊丽红,郑晓英,张宪华,等.ω-3多不饱和脂肪酸在严重脓毒症机械通气早期的保护作用的研究.国际医药卫生导报,2011,17: 142-146.
13.	梁晓,方利洲,张燕,等.ω-3鱼油脂肪乳对严重脓毒症的抑制作用观察.中国实用医药,2009,4: 158-159.
14.	Sungurtekin H, De AğG irmenci S, Sungurtekin U,et al.Comparison of the effects of different intravenous fat emulsions in patients with systemic inflammatory response syndrome and sepsis.Nutr Clin Pract,2011,26:665-671.
15.	Khor BS,Liaw SJ,Shih HC,et al.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.
16.	Mayer K,Fegbeutel C,Hattar K,et al.Omega-3 vs.omega-6 lipid emulsions exert differential influence on neutrophils in septic shock patients: impact on plasma fatty acids and lipid mediator generation.Intensive care medi,2003,29: 1472-1481.
17.	Barbosa VM,Miles EA,Calhau C,et al.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.Critical care,2010,14:R5.
18.	Mayer K,Gokorsch S,Fegbeutel C,et al.Parenteral nutrition with fish oil modulates cytokine response in patients with sepsis.Am J Respir Crit Care Med,2003,167:1321-1328.
19.	Grecu I, Mirea L, Grinteseu I.Parenteral fish oil supplementation in patients with abdominal sepsis.Clin Nutr, 2003, 22(suppl 1):S23.
20.	Mayer K,Seeger W.Fish oil in critical illness.Curr opin clin nutr metab care.2008,11: 121-127.
21.	Sijben JW,Calder PC.Differential immunomodulation with long-chain n-3 PUFA in health and chronic disease.Proceed Nutr Soc,2007,66:237-259.
22.	Peterson LD,Jeffery NM,Thies F,et al.Eicosapentaenoic and docosahexaenoic acids alter rat spleen leukocyte fatty acid composition and prostaglandin E2 production but have different effects on lymphocyte functions and cell-mediated immunity.Lipids,1998,33:171-180.
23.	Chapkin RS,Akoh CC,Miller CC.Influence of dietary n-3 fatty acids on macrophage glycerophospholipid molecular species and peptidoleukotriene synthesis.J Lipid Res,1991,32:1205-1213.
24.	Ait-Said F,Elalamy I,Werts C,et al.Inhibition by eicosapentaenoic acid of IL-1beta-induced PGHS-2 expression in human microvascular endothelial cells: involvement of lipoxygenase-derived metabolites and p38 MAPK pathway.Biochim Biophys Acta,2003,1631:77-84.
25.	Tsou SS,Chiu WC,Yeh CL,et al.Effects of omega-3 fatty acids on inflammatory mediators and splenocyte cytokine mRNA expressions in rats with polymicrobial sepsis.Nutrition,2008,24:484-491.
26.	Zhao G,Etherton TD,Martin KR,et al.Anti-inflammatory effects of polyunsaturated fatty acids in THP-1 cells.Biochem Biophys Res Commun,2005,336:909-917.

1. 盛虹.鱼油在脓毒血症中的应用.上海交通大学学报:医学版,2010,30: 46-49.
2. Heller AR,Rossler S,Litz RJ,et al.Omega-3 fatty acids improve the diagnosis-related clinical outcome.Critical care medicine,2006,34: 972-979.
3. Bone RC,Balk RA,Cerra FB,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.1992.Chest,2009,136(5 Suppl): e28.
4. Jadad AR,Moore RA,Carroll D,et al.Assessing the quality of reports of randomized clinical trials:is blinding necessary? Controlled clinical trials,1996,17:1-12.
5. 赵凯峰,张弘,张颖,等.早期静脉应用ω-3鱼油脂肪乳对脓毒症所致ARDS的临床疗效观察.山东医药,2011,51:110-111.
6. 曲爱君,徐珞.鱼油脂肪乳对脓毒症患者免疫功能的调节作用观察.山东医药,2009,49:13-15.
7. 赵凯峰,张弘,张坤,等.ω-3鱼油脂肪乳对脓毒症患者抗生素使用的影响,承德医学院学报,2012,29:148-149.
8. 刘寒.ω-3多不饱和脂肪酸对脓毒症免疫功能的影响.山东大学; 2011(学位论文).
9. 邹曰坤,刘于.ω-3脂肪酸对脓毒症病人治疗的影响.肠外与肠内营养,2009,16:222-224.
10. 干朝晖,张立群.ω-3鱼油脂肪乳剂对感染性休克患者TNF-α、IL-6水平的影响.浙江中西医结合杂志,2012,22:785-786.
11. 黄志平.鱼油治疗感染性休克的临床疗效观察.Strait Pharmaceutical Journal,2011, 23: 99-101.
12. 熊丽红,郑晓英,张宪华,等.ω-3多不饱和脂肪酸在严重脓毒症机械通气早期的保护作用的研究.国际医药卫生导报,2011,17: 142-146.
13. 梁晓,方利洲,张燕,等.ω-3鱼油脂肪乳对严重脓毒症的抑制作用观察.中国实用医药,2009,4: 158-159.
14. Sungurtekin H, De AğG irmenci S, Sungurtekin U,et al.Comparison of the effects of different intravenous fat emulsions in patients with systemic inflammatory response syndrome and sepsis.Nutr Clin Pract,2011,26:665-671.
15. Khor BS,Liaw SJ,Shih HC,et al.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.
16. Mayer K,Fegbeutel C,Hattar K,et al.Omega-3 vs.omega-6 lipid emulsions exert differential influence on neutrophils in septic shock patients: impact on plasma fatty acids and lipid mediator generation.Intensive care medi,2003,29: 1472-1481.
17. Barbosa VM,Miles EA,Calhau C,et al.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.Critical care,2010,14:R5.
18. Mayer K,Gokorsch S,Fegbeutel C,et al.Parenteral nutrition with fish oil modulates cytokine response in patients with sepsis.Am J Respir Crit Care Med,2003,167:1321-1328.
19. Grecu I, Mirea L, Grinteseu I.Parenteral fish oil supplementation in patients with abdominal sepsis.Clin Nutr, 2003, 22(suppl 1):S23.
20. Mayer K,Seeger W.Fish oil in critical illness.Curr opin clin nutr metab care.2008,11: 121-127.
21. Sijben JW,Calder PC.Differential immunomodulation with long-chain n-3 PUFA in health and chronic disease.Proceed Nutr Soc,2007,66:237-259.
22. Peterson LD,Jeffery NM,Thies F,et al.Eicosapentaenoic and docosahexaenoic acids alter rat spleen leukocyte fatty acid composition and prostaglandin E2 production but have different effects on lymphocyte functions and cell-mediated immunity.Lipids,1998,33:171-180.
23. Chapkin RS,Akoh CC,Miller CC.Influence of dietary n-3 fatty acids on macrophage glycerophospholipid molecular species and peptidoleukotriene synthesis.J Lipid Res,1991,32:1205-1213.
24. Ait-Said F,Elalamy I,Werts C,et al.Inhibition by eicosapentaenoic acid of IL-1beta-induced PGHS-2 expression in human microvascular endothelial cells: involvement of lipoxygenase-derived metabolites and p38 MAPK pathway.Biochim Biophys Acta,2003,1631:77-84.
25. Tsou SS,Chiu WC,Yeh CL,et al.Effects of omega-3 fatty acids on inflammatory mediators and splenocyte cytokine mRNA expressions in rats with polymicrobial sepsis.Nutrition,2008,24:484-491.
26. Zhao G,Etherton TD,Martin KR,et al.Anti-inflammatory effects of polyunsaturated fatty acids in THP-1 cells.Biochem Biophys Res Commun,2005,336:909-917.

Chinese Journal of Respiratory and Critical Care Medicine

Efficacy of Fish Oil Containing Lipid Emulsion in Sepsis: A Meta-Analysis

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