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Glutamine supplementation in acute pancreatitis: a meta-analysis of randomized controlled trials.
Pancreatology. 2013 Sep-Oct; 13(5):468-74.P

Abstract

BACKGROUND

There is emerging evidence that glutamine supplementation should be considered in patients with acute and critical illness associated with a catabolic response. There are reports of glutamine supplementation in acute pancreatitis but the results of these studies are conflicting. The aim of this study was to systematically review the randomised controlled trials (RCT) of glutamine in patients with acute pancreatitis.

METHODS

The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, SCOPUS and 3 major Chinese databases were searched. The outcomes studied were mortality, total infectious complications, and length of hospital stay. A random effects model was used for meta-analysis of the outcomes in the included trials. A number of pre-specified subgroup analyses were also conducted. The summary estimates were reported as risk ratio (RR) for categorical variables and mean difference (MD) for continuous variables together with the corresponding 95% confidence interval.

RESULTS

Twelve RCT that enrolled 505 patients with acute pancreatitis were included in the final analysis. Overall, glutamine supplementation resulted in a significantly reduced risk of mortality (RR 0.30; 95% CI, 0.15 to 0.60; P < 0.001) and total infectious complications (RR 0.58; 95% CI, 0.39 to 0.87; P = 0.009) but not length of hospital stay (MD -1.35; 95% CI, -3.25 to 0.56, P = 0.17). In the subgroup analyses, only patients who received parenteral nutrition and those who received glutamine in combination with other immunonutrients demonstrated a statistically significant benefit in terms of all the studied outcomes.

CONCLUSIONS

This meta-analysis demonstrates a clear advantage for glutamine supplementation in patients with acute pancreatitis who receive total parenteral nutrition. Patients with acute pancreatitis who receive enteral nutrition do not require glutamine supplementation. Further studies are warranted to determine whether patients who receive combined enteral and parenteral nutrition need glutamine supplementation.

Authors+Show Affiliations

Department of Surgery, University of Auckland, Auckland, New Zealand; Nutrition Services, Auckland City Hospital, Auckland, New Zealand.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

24075510

Citation

Asrani, Varsha, et al. "Glutamine Supplementation in Acute Pancreatitis: a Meta-analysis of Randomized Controlled Trials." Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.], vol. 13, no. 5, 2013, pp. 468-74.
Asrani V, Chang WK, Dong Z, et al. Glutamine supplementation in acute pancreatitis: a meta-analysis of randomized controlled trials. Pancreatology. 2013;13(5):468-74.
Asrani, V., Chang, W. K., Dong, Z., Hardy, G., Windsor, J. A., & Petrov, M. S. (2013). Glutamine supplementation in acute pancreatitis: a meta-analysis of randomized controlled trials. Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.], 13(5), 468-74. https://doi.org/10.1016/j.pan.2013.07.282
Asrani V, et al. Glutamine Supplementation in Acute Pancreatitis: a Meta-analysis of Randomized Controlled Trials. Pancreatology. 2013 Sep-Oct;13(5):468-74. PubMed PMID: 24075510.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Glutamine supplementation in acute pancreatitis: a meta-analysis of randomized controlled trials. AU - Asrani,Varsha, AU - Chang,Wai Keat, AU - Dong,Zhiyong, AU - Hardy,Gil, AU - Windsor,John A, AU - Petrov,Maxim S, Y1 - 2013/08/06/ PY - 2013/05/07/received PY - 2013/07/11/revised PY - 2013/07/20/accepted PY - 2013/10/1/entrez PY - 2013/10/1/pubmed PY - 2014/5/6/medline KW - Acute pancreatitis KW - Enteral nutrition KW - Glutamine KW - Parenteral nutrition KW - Pharmaconutrition SP - 468 EP - 74 JF - Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] JO - Pancreatology VL - 13 IS - 5 N2 - BACKGROUND: There is emerging evidence that glutamine supplementation should be considered in patients with acute and critical illness associated with a catabolic response. There are reports of glutamine supplementation in acute pancreatitis but the results of these studies are conflicting. The aim of this study was to systematically review the randomised controlled trials (RCT) of glutamine in patients with acute pancreatitis. METHODS: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, SCOPUS and 3 major Chinese databases were searched. The outcomes studied were mortality, total infectious complications, and length of hospital stay. A random effects model was used for meta-analysis of the outcomes in the included trials. A number of pre-specified subgroup analyses were also conducted. The summary estimates were reported as risk ratio (RR) for categorical variables and mean difference (MD) for continuous variables together with the corresponding 95% confidence interval. RESULTS: Twelve RCT that enrolled 505 patients with acute pancreatitis were included in the final analysis. Overall, glutamine supplementation resulted in a significantly reduced risk of mortality (RR 0.30; 95% CI, 0.15 to 0.60; P < 0.001) and total infectious complications (RR 0.58; 95% CI, 0.39 to 0.87; P = 0.009) but not length of hospital stay (MD -1.35; 95% CI, -3.25 to 0.56, P = 0.17). In the subgroup analyses, only patients who received parenteral nutrition and those who received glutamine in combination with other immunonutrients demonstrated a statistically significant benefit in terms of all the studied outcomes. CONCLUSIONS: This meta-analysis demonstrates a clear advantage for glutamine supplementation in patients with acute pancreatitis who receive total parenteral nutrition. Patients with acute pancreatitis who receive enteral nutrition do not require glutamine supplementation. Further studies are warranted to determine whether patients who receive combined enteral and parenteral nutrition need glutamine supplementation. SN - 1424-3911 UR - https://www.unboundmedicine.com/medline/citation/24075510/Glutamine_supplementation_in_acute_pancreatitis:_a_meta_analysis_of_randomized_controlled_trials_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1424-3903(13)00760-6 DB - PRIME DP - Unbound Medicine ER -