Effect of parenteral glutamine supplementation on clinical outcomes in critical ill patients: a meta-analysis

doi:10.3877/cma.j.issn.1674-6880.2018.01.007

Abstract

Abstract:

Objective

To evaluate the immunonutrition function and clinical outcomes of glutamine-supplemented parenteral nutrition treatment on critically ill patients.

Methods

Randomized controlled trials which focused on clinical outcomes (like the mortality, the infection rate and the length of stay) of converntional parenteral nutrition treatment (the control group) and glutamine-supplemented parenteral nutrition treatment (the glutamine group) on critically ill patients were systematically retrieved from Embase, Medline, Cochrane Central Register of Controlled Trials, The Cochrane Database of Systematic Reviews, CNKI database, CQVIP database, Wan Fang database and CMB databases from their inception to December 2016. Included articles were independently screened, extracted and evaluated by two reviewers according to the inclusion and exclusion criteria and then conducted the meta-analysis by RevMan 5.2.0.

Results

A total of 1 708 patients in 18 studies were included. Meta-analysis showed that the hospital mortality in the glutamine group was much lower than that in the control group [RR=0.63, 95%CI (0.47, 0.84), Z=3.16, P=0.002]. However, there were no significant differences in the ICU mortality [RR=1.00, 95%CI (0.83, 1.22), Z=0.04, P=0.97], 6-month mortality [RR=0.95, 95%CI (0.67, 1.34), Z=0.29, P=0.77], pulmonary infection [RR=0.91, 95%CI (0.62, 1.32), Z=0.52, P=0.61], urinary tract infection [RR=0.79, 95%CI (0.37, 1.67), Z=0.62, P=0.54], bacteremia [RR=0.52, 95%CI (0.21, 1.33), Z=1.36, P=0.18], catheter-related infection [RR=0.69, 95%CI (0.32, 1.49), Z=0.95, P=0.34], and other infections [RR=0.94, 95%CI (0.80, 1.10), Z=0.81, P=0.42] between the two groups. The hospital length of stay[WMD=-0.26, 95%CI (-3.81, 3.28), Z=0.15, P=0.88] and ICU length of stay [WMD=-1.04, 95%CI (3.95, 1.87), Z=0.70, P=0.48] also showed no significant differences between the two groups.

Conclusion

Parenteral glutamine supplementation can not improve the clinical outcomes of critically ill patients.

Key words: Glutamine, Parenteral nutrition, Meta-analysis, Critically ill

Xiaowei He, Sheng Lu, Tao Zhong, Wei Xu, Bing Yan, Feilian Wu, Li Qiu, Yu He, Kankai Tang. Effect of parenteral glutamine supplementation on clinical outcomes in critical ill patients: a meta-analysis[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2018, 11(01): 41-48.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhwzzyxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-6880.2018.01.007

https://zhwzzyxzz.cma-cmc.com.cn/EN/Y2018/V11/I01/41

Figures/Tables 7

References 30

[1]	Heyland D, Muscedere J, Wischmeyer PE, et al. A randomized trial of glutamine and antioxidants in critically ill patients[J]. N Engl J Med, 2013, 368 (16): 1489-1497.
[2]	Oudemanss-van Straaten HM, Bosman RJ, Treskes M, et al. Plasma glutamine depletion and patient outcome in acute ICU admissions[J]. Intensive Care Med, 2001, 27 (1): 84-90.
[3]	Bollhalder L, Pfeil AM, Tomonaga Y, et al. A syste-matic literature review and meta-analysis of randomized clinical trials of parenteral glutamine supplementation[J]. Clin Nutr, 2013, 32 (2): 213-223.
[4]	Wernerman J. How to understand the results of stu-dies of glutamine supplimentation[J]. Crit Care, 2015 (19): 385.
[5]	潘小东，汤鲁明，孙来芳.危重神经系统疾病患者肠内营养与胃内营养对预后影响的Meta分析[J/CD].中华危重症医学杂志（电子版），2015，8（1）：29-34.
[6]	Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?[J]. Control Clin Trials, 1996, 17 (1): 1-12.
[7]	Griffiths RD, Allen KD, Andrews FJ, et al. Infection, multiple organ failure, and survival in the intensive care unit: influence of glutamine-supplemented parenteral nutrition on acquired infection[J]. Nutrition, 2002, 18 (7-8): 546-552.
[8]	Powell-Tuck J, Jamieson CP, Bettany GE, et al. A double blind, randomised, controlled trial of glutamine supplementation in parenteral nutrition[J]. Gut, 1999, 45 (1): 82-88.
[9]	Goeters C, Wenn A, Mertes N, et al. Parenteral L-alanyl-L-glutamine improves 6-month outcome in cretically ill patients[J]. Crit Care Med, 2002, 30 (9): 2032-2037.
[10]	Fuentes-Orozco C, Anaya-Prado R, Gonzalez-Ojeda A, et al. L-alanyl-L-glutamine-supplemented parenteral nutrition improves infectious morbidity in secondary peritonitis[J]. Clin Nutr, 2004, 23 (1): 13-21.
[11]	Dechelotte P, Hasselmann M, Cynober L, et al. L-alanyl-L-glutamine dipeptide-supplemented total parenteral nutrition reduces infectious complications and glucose intolerance in critically ill patients: the French controlled, randomized, double-blind, multicenter study[J]. Crit Care Med, 2006, 34 (3): 598-604.
[12]	Sahin H, Mercanligil SM, Inanc N, et al. Effects of glutamine-enriched total parenteral nutrition on acute pancreatitis[J]. Eur J Clin Nutr, 2007, 61 (12): 1429-1434.
[13]	Fuentes-Orozco C, Cervantes-Guevara G, Mucino-Hern-andez I, et al. L-alanyl-L-glutamine-supplemented parenteral nutrition decreases infectious morbidity rate in patients with severe acute pancreatitis[J]. J Parenter Enteral Nutr, 2008, 32 (4): 403-411.
[14]	Duska F, Fric M, Waldauf P, et al. Frequent intra-venous pulses of growth hormone together with glutamine supplementation in prolonged critical illness after multiple trauma: effects on nitrogen balance, insulin resistance, and substrate oxidation[J]. Crit Care Med, 2008, 36 (6): 1707-1713.
[15]	Estivariz CF, Griffith DP, Luo M, et al. Efficacy of parenteral nutrition supplemented with glutamine dipeptide to decrease hospital infections in critically ill surgical patients[J]. J Parenter Enteral Nutr, 2008, 32 (4): 389-402.
[16]	Perez-Barcena J, Crespi C, Regueiro V, et al. Lack of effect of glutamine administration to boost the innate immune system response in trauma patients in the intensive care unit[J]. Crit Care, 2010, 14 (6): R233.
[17]	Cekmen N, Aydin A, Erdemli O. The impact of L-alanyl-L-glutamine dipeptide supplemented total parenteral nutrition on clinical outcome in critically patients[J]. E-SPEN, Euro e-J Clin Nutr Metab, 2011, 6 (2): e64-e67.
[18]	Grau T, Bonet A, Minambres E, et al. The effect of L-alanyl-L-glutamine dipeptide supplemented total parenteral nutrition on infectious morbidity and insulin sensitivity in critically ill patients[J]. Crit Care Med, 2011, 39 (6): 1263-1268.
[19]	Andrews PJ, Avenell A, Noble DW, et al. Randomised trial of glutamine, selenium, or both, to supplement parenteral nutrition for critically ill patients[J]. BMJ, 2011 (342): d1542.
[20]	Ziegler T, May A, Hebbar G, et al. LB001-mon glutamine dipeptide-supplemented parenteral nutrition in surgical ICU patients: results of an American randomized, double-blind, multicenter trial[J]. Clin Nutr Suppl, 2012, 7 (1): 265.
[21]	Zhao G, Zhang JG, Wu HS, et al. Effects of different resuscitation fluid on severe acute pancreatitis[J]. World J Gastroenterol, 2013, 19 (13): 2044-2052.
[22]	Perez-Barcena J, Marse P, Zabalegui-Perez A, et al. A randomized trial of intravenous glutamine supplementation in trauma ICU patients[J]. Intensive Care Med, 2014, 40 (4): 539-547.
[23]	Yeh DD, Fuentes E, Quraishi SA, et al. Adequate nutrition may get you home: effect of caloric/protein deficits on the discharge destination of critically ill surgical patients[J]. JPEN J Parenter Enteral Nutr,2016, 40 (1): 37-44.
[24]	Choi EY, Park DA, Park J. Calorie intake of enteral nutrition and clinical outcomes in acutely critically ill patients: a meta-analysis of randomized controlled trials[J]. J Parenter Enteral Nutr, 2015, 39 (3): 291-300.
[25]	Nienaber A, Dolman RC, van Graan AE, et al. Pre-valence of glutamine deficiency in ICU patients: a cross-sectional analytical study[J]. Nutr J, 2016, 15 (1): 73.
[26]	van Zanten AR, Dhaliwal R, Garrel D, et al. Enteral glutamine supplementation in critically ill patients: systematic review and meta-analysis[J]. Crit Care, 2015 (19): 294.
[27]	Chen QH, Yang Y, He HL, et al. The effect of glutamine therapy on outcomes in critically ill patients: a meta-analysis of randomized controlled trials[J]. Crit Care, 2014, 18 (1): R8.
[28]	Rodas PC, Rooyackers O, Hebert C, et al. Glutamine and glutathione at ICU admission in relation to outcome[J]. Clin Sci (Lond), 2012, 122 (12): 591-597.
[29]	王松志，吴乐军，吴应虬，等.谷氨酰胺强化肠外营养对全身炎症反应综合征患者影响的临床研究[J].中国临床药理学杂志，2015，31（8）：618-620，634.
[30]	Pérez-Bárcena J, Crespí C, Regueiro V, et al. Lack of effect of glutamine administration to boost the innate immune system response in trauma patients in the intensive care unit[J]. Crit Care, 2010, 14 (6): R233.

文献	国别	病例数（干预组/常规组）	谷氨酰胺给药方式	结局指标	Jadad评分（分）
Griffiths等1997^[7]	英国	42/42	肠外营养	①②③	5
Poweel-Tuck等1999^[8]	英国	83/85	肠外营养	①③	4
Goeters等2002^[9]	德国	33/35	静脉注射	①③	3
Fuentes-Orozco等2004^[10]	墨西哥	17/16	肠外营养	①②③	2
Dechelotte等2006^[11]	法国	58/56	肠外营养	①②③	5
Sahin等2007^[12]	土耳其	20/20	肠外营养	①③	2
Fuentes-Orozco等2008^[13]	墨西哥	22/22	肠外营养	①②③	4
Duska等2008^[14]	捷克	10/10	肠外营养	①	4
Estivariz等2008^[15]	美国	32/31	肠外营养	①②③	5
Perez-Barcena等2010^[16]	西班牙	23/20	肠外营养	①②③	3
Cekman等2011^[17]	土耳其	15/15	肠外营养	①③	5
Grau等2011^[18]	西班牙	59/68	肠外营养	①②③	4
Andrew等2011^[19]	苏格兰	250/252	肠外营养	①②③	5
Ziegler等2013^[20]	美国	75/75	肠外营养	①②③	5
Zhao等2013^[21]	中国	40/40	静脉注射	①②③	4
Perez-Barcena等2014^[22]	西班牙	71/71	静脉注射	①②③	5

文献	国别	病例数（干预组/常规组）	谷氨酰胺给药方式	结局指标	Jadad评分（分）
Griffiths等1997^[7]	英国	42/42	肠外营养	①②③	5
Poweel-Tuck等1999^[8]	英国	83/85	肠外营养	①③	4
Goeters等2002^[9]	德国	33/35	静脉注射	①③	3
Fuentes-Orozco等2004^[10]	墨西哥	17/16	肠外营养	①②③	2
Dechelotte等2006^[11]	法国	58/56	肠外营养	①②③	5
Sahin等2007^[12]	土耳其	20/20	肠外营养	①③	2
Fuentes-Orozco等2008^[13]	墨西哥	22/22	肠外营养	①②③	4
Duska等2008^[14]	捷克	10/10	肠外营养	①	4
Estivariz等2008^[15]	美国	32/31	肠外营养	①②③	5
Perez-Barcena等2010^[16]	西班牙	23/20	肠外营养	①②③	3
Cekman等2011^[17]	土耳其	15/15	肠外营养	①③	5
Grau等2011^[18]	西班牙	59/68	肠外营养	①②③	4
Andrew等2011^[19]	苏格兰	250/252	肠外营养	①②③	5
Ziegler等2013^[20]	美国	75/75	肠外营养	①②③	5
Zhao等2013^[21]	中国	40/40	静脉注射	①②③	4
Perez-Barcena等2014^[22]	西班牙	71/71	静脉注射	①②③	5

Please choose a citation manager

Content to export