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A systematic literature review and meta-analysis of randomized clinical trials of parenteral glutamine supplementation.
Clin Nutr. 2013 Apr; 32(2):213-23.CN

Abstract

BACKGROUND & AIMS

Glutamine supplementation has been associated with reduced mortality, infections and hospital length of stay in critically ill patients and patients undergoing major surgery. We carried out a meta-analysis to examine randomized clinical trial (RCT)-based evidence of these effects.

METHODS

Based on a systematic database search, RCTs published since 1990 were included if they evaluated the effect of parenteral glutamine supplementation against a background of parenteral nutrition. Enteral (tube) feeding in a proportion of patients was allowable. Information on RCT methodology, quality and outcomes was extracted. Random effects meta-analysis followed the DerSimonian-Laird approach.

RESULTS

Forty RCTs were eligible for meta-analysis. Parenteral glutamine supplementation was associated with a non-significant 11% reduction in short-term mortality (RR = 0.89; 95% CI, 0.77-1.04). Infections were significantly reduced (RR = 0.83; 95% CI, 0.72-0.95) and length of stay was 2.35 days shorter (95% CI, -3.68 to -1.02) in the glutamine arms. Meta-analysis results were strongly influenced by one recent trial. An element of publication bias could not be excluded.

CONCLUSION

Parenteral glutamine supplementation in severely ill patients may reduce infections, length of stay and mortality, but substantial uncertainty remains. Unlike previous meta-analyses, we could not demonstrate a significant reduction in mortality.

Authors+Show Affiliations

Institute of Social and Preventive Medicine, Medical Economics Unit, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland. lea.bollhalder@ifspm.uzh.chNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

23196117

Citation

Bollhalder, Lea, et al. "A Systematic Literature Review and Meta-analysis of Randomized Clinical Trials of Parenteral Glutamine Supplementation." Clinical Nutrition (Edinburgh, Scotland), vol. 32, no. 2, 2013, pp. 213-23.
Bollhalder L, Pfeil AM, Tomonaga Y, et al. A systematic literature review and meta-analysis of randomized clinical trials of parenteral glutamine supplementation. Clin Nutr. 2013;32(2):213-23.
Bollhalder, L., Pfeil, A. M., Tomonaga, Y., & Schwenkglenks, M. (2013). A systematic literature review and meta-analysis of randomized clinical trials of parenteral glutamine supplementation. Clinical Nutrition (Edinburgh, Scotland), 32(2), 213-23. https://doi.org/10.1016/j.clnu.2012.11.003
Bollhalder L, et al. A Systematic Literature Review and Meta-analysis of Randomized Clinical Trials of Parenteral Glutamine Supplementation. Clin Nutr. 2013;32(2):213-23. PubMed PMID: 23196117.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A systematic literature review and meta-analysis of randomized clinical trials of parenteral glutamine supplementation. AU - Bollhalder,Lea, AU - Pfeil,Alena M, AU - Tomonaga,Yuki, AU - Schwenkglenks,Matthias, Y1 - 2012/11/09/ PY - 2012/05/01/received PY - 2012/11/02/revised PY - 2012/11/05/accepted PY - 2012/12/1/entrez PY - 2012/12/1/pubmed PY - 2013/9/24/medline SP - 213 EP - 23 JF - Clinical nutrition (Edinburgh, Scotland) JO - Clin Nutr VL - 32 IS - 2 N2 - BACKGROUND & AIMS: Glutamine supplementation has been associated with reduced mortality, infections and hospital length of stay in critically ill patients and patients undergoing major surgery. We carried out a meta-analysis to examine randomized clinical trial (RCT)-based evidence of these effects. METHODS: Based on a systematic database search, RCTs published since 1990 were included if they evaluated the effect of parenteral glutamine supplementation against a background of parenteral nutrition. Enteral (tube) feeding in a proportion of patients was allowable. Information on RCT methodology, quality and outcomes was extracted. Random effects meta-analysis followed the DerSimonian-Laird approach. RESULTS: Forty RCTs were eligible for meta-analysis. Parenteral glutamine supplementation was associated with a non-significant 11% reduction in short-term mortality (RR = 0.89; 95% CI, 0.77-1.04). Infections were significantly reduced (RR = 0.83; 95% CI, 0.72-0.95) and length of stay was 2.35 days shorter (95% CI, -3.68 to -1.02) in the glutamine arms. Meta-analysis results were strongly influenced by one recent trial. An element of publication bias could not be excluded. CONCLUSION: Parenteral glutamine supplementation in severely ill patients may reduce infections, length of stay and mortality, but substantial uncertainty remains. Unlike previous meta-analyses, we could not demonstrate a significant reduction in mortality. SN - 1532-1983 UR - https://www.unboundmedicine.com/medline/citation/23196117/A_systematic_literature_review_and_meta_analysis_of_randomized_clinical_trials_of_parenteral_glutamine_supplementation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0261-5614(12)00235-X DB - PRIME DP - Unbound Medicine ER -