Effect of Clinical Nutritional Supplementation for Systematic Inflammatory Response Syndrome: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

MAI Su mu ¹ , XU Feng lei ² , WU Tai xiang ³ , DONG Xu nan ¹ , LI Li ¹ , PENG Peng ¹

1 The First Affiliated Hospital of Xinjiang Medical University; Urumqi 830000; China2 The Central Hospital of Ktrialsaramay; Karamay 8340003 Chinese Evidence Based Medicine Centre/Clinical Epidemiology Resource and Training Centre （Chengdu）; West China Hospital; Sichuan University; Chengdu 610041;

Corresponding author：

Keywords：

Systematic inflammatory response syndrome; Nutritional supplementation; Systematic review

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Objective 　To assess the effect and safety of clinical nutritional supplementation with different patterns for treating systematic inflammatory response syndrome (SIRS).
Methods 　Randomized controlled trials (RCTs) were identified from MEDLINE (1996 to Nov. 2004), EMBASE (1984 to Nov. 2002), Cochrane Controlled Trials Register (Issue 4, 2004), Chinese Cochrane Centre Database (Issue 4, 2004), CBMdisc (1978 to Nov. 2004). We handsearched related published and unpublished data and their references. All RCTs of nutritional interventions for SIRS were included. Data were extracted and evaluated by two reviewers independently with designed extraction form. RevMan 4.2.7 software was used for data analysis.
Results 　Six RCTs involving 353 patients were included. All the results of meta-analysis were listed as the following: ① Mortality: compared with routine nutrition, one study showed that glutamine had a statistical difference with RR 0.67 and 95%CI 0.31 to 1.32. Compared with no treatment, one study showed selenium had a statistical difference with RR 1.19, 95%CI 0.59 to 2.41. ② Compared with routine nutrition, one study showed that glutamine had a statistical difference on reducing the ratio of nasocomial infection of SIRS with RR 0.5, 95%CI 0.27 to 0.91, but had no statistical difference on reducing the ratio of multiple organ dysfunction syndrome with RR 1.53, 95%CI 0.64 to 3.66. ③ Improvement of the critical condition of SIRS: compared with routine nutrition, one study showed that glutamine had a statistical differences with WMD 4.0, 95%CI 2.36 to 5.64; compared with high calorie intake, two studies showed low calorie intake had a statistical difference with WMD 4.9, 95%CI 1.76 to 8.04. ④ Reduction of the complication of hyperglycemia and hypertriglyceridemia: compared with high calorie intake, one study showed low calorie intake had statistical difference with WMD －0.70, 95%CI －1.20 to －0.20 and WMD －1.80, 95% CI －2.42 to －1.16 respectively and all P≤0.01. ⑤ Increasing of the plasma IgG concentration: compared with routine nutrition, two studies showed that glutamine had a statistical difference with WMD 4.20, 95% CI 2.23 to 6.16. ⑥ Increasing of the nitrogen balance, intestinal permeability, the level of plasma concentration of anlbumin, prealbumin and TRF: compared with control interventions, glutamine, low calorie intake, selenium supplementation and fructose-glucose-xylitol mixture showed no statistical difference.
Conclusions 　Glutamine, low calorie intake, selenium supplementation, FGX mixture may decrease the complication of infection or metabolism and be better than the controlled interventions; but there is no benefit on reducing the rate of death result from SIRS compared with controlled interventions. The evidence of most RCTs with poor quality is too weak to draw a conclusion. More high quality trials are required.

Citation： MAI Su mu,XU Feng lei,WU Tai xiang,DONG Xu nan,LI Li,PENG Peng. Effect of Clinical Nutritional Supplementation for Systematic Inflammatory Response Syndrome: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2005, 05(2): 140-147. doi: Copy

1.	黄武, 刘幼硕. 谷氨酞胺强化的营养支持对老年SIRS的调理作用[J]. 肠外与肠内营养, 2002;9(4): 199～200.
2.	姜海平, 刘春安, 王大安. 谷氨酰胺强化肠外营养对普外科全身炎症反应综合征的影响[J]. 中国病理生理杂志, 2003;19(6): 847～848.
3.	刘幼硕, 龙利民, 屈晓冰, 那日苏, 何福清. 不同热能PN对对老年全身炎症反应综合征的治疗研究[J]. 湖南医科大学学报, 2000;25(3): 251～253.
4.	刘幼硕, 屈晓冰, 庞新利, 杨川. 应用合理热能肠外营养治疗高龄病人全身炎症反应综合征[J]. 肠外与肠内营养, 2000;7(2);63～66.
5.	姜海平, 刘春安, 王大安. 肠外营养联合谷氨酰胺在普外可危重病人的应用[J]. 岭南现代外科, 2004;4(1): 41～43.
6.	Bone RC, Balk RA, Cerra FB. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis[J]. Chest, 1992;101(6): 1 028.
7.	Hirasawa H, Sugai T, Ohtake Y, Oda S, Matsuda K, Kitamura N. Blood purification for prevention and treatment of multiple organ failure[J]. World J Surg, 1996;20(4): 482-486.
8.	Neoshol me EA, Callder PC. The proposed role of glutamine in some cells of the immune system and speculative consequences for the whole animal[J]. Nutrition, 1997;13(7-8): 728-730.
9.	Juni P, Altman DG, Eger M. Assessing the quality of controlled clinical trials[J]. BMJ, 2001;323(7 303): 42-46.
10.	Huang W, Liu YS. The efficacy of glutamine-intensified nutrition support on systemic inflammatory response syndrome in the elderly[J]. Parenteral & Enteral Nutrition, 2002;9 (4): 199-200.
11.	Conejero R, Bonet A, Grau T, Esteban A, Mesejo A, Montejo JC, Lopez J, Acosta JA. Effect of a glutamine-enriched enteral diet on intestinal permeability and infectious morbidity at 28 days in critically ill patients with systemic inflammatory response syndrome: a randomized, single-blind, prospective, multicenter study[J]. Nutrition, 2002;18(9): 716-721.
12.	Jiang HP, Liu CA, Wang DA. Effect of glutamine-combined with parenteral nutrition in systematic inflammatory response syndrome patients of general surgery[J]. Chinese Journal of Pathophysiology, 2003;19 (6): 847-848.
13.	Liu YS, Long LM, Qu XB, Na RS, He FQ. The efficacy of parenteral nutrition with different energy for systemic inflammatory response syndrome (SIRS) in the aged[J]. Bulletin of Hunan Medical University, 2000;25(3): 251-253.
14.	Angstwurm, Matthias WA, Schottdorf, Juergen MS, Schopohl, Jochen MD;Gaertner, Roland. Selenium replacement in patients with severe systemic inflammatory response syndrome improves clinical outcome[J]. Critical Care Medicine, 1999;27(9): 1 807-1 813.
15.	Lopez Martinez J, Sanchez Castilla M, de Juana Velasco P, Diaz Abad R, Rodriguez Roldan JM, Garcia de Lorenzo y Mateos A, Del Nogal Saez F. Non-glucose carbohydrates in the parenteral nutrition of patients with systemic inflammatory response syndrome[J]. Nutricion Hospitalaria, 1999;14 (2):71-80.
16.	Weimann A, Bastian L, Bischoff WE, Grotz M, Hansel M, Lotz J, Trautwein C, Tusch G, Schlitt HJ, Regel G. Influence of arginine, omega-3 fatty acids and nucleotide-supplemented enteral support on systemic inflammatory response syndrome and multiple organ failure in patients after severe trauma[J]. Nutrition,1998;14 (2): 165-172.
17.	Bastian L, Weimann A, Regel G, Tscherne H. Is modification of systemic inflammatory response syndrome and multiple organ failure by parenteral feeding possible[J]? Langenbecks Archiv fur Chirurgie-Supplement-Kongressband, 1998;115: 1 083-1 085.
18.	Cerra FB, McPherson JP, Konstantinides FN, Konstantinides NN, Teasley KM. Enteral nutrition does not prevent multiple organ failure syndrome (MOFS) after sepsis[J]. Surgery, 1988 ;104(4): 727-733.
19.	Bower RH, Cerra FB, Bershadsky B, Licari JJ, Hoyt DB, Jensen GL, Van Buren CT, Rothkopf MM, Daly JM, Adelsberg BR. Early enteral administration of a formula (Impact) supplemented with arginine, nucleotides, and fish oil in intensive care unit patients: results of a multicenter, prospective, randomized, clinical trial [J]. Critical Care Medicine, 1995;23(3): 436-449.
20.	Liu YS, Qu XB, Pang XL, Yang C. A study on suitable energy of parenteral nutrition with for octogenarian patients with systemic inflammatory response syndrome [J]. Parenteral & Enteral Nutrition, 2000;7 (2): 63-66.
21.	Weimann A, Bastian L, Bischoff WE, Grotz M, BodeBoger S, Hansel M, Lotz J, Regel G. The influence of enteral nutrition with arginine, omega 3 fatty acids and nucleotides supplemented diet of systemic inflammatory response syndrome in severe multiple injury[J]. Intensive Care Medicine, 1996;2 (Suppl 3): s353.
22.	Weimann A, Bastian L, Grotz M, Hansel M, Schlitt HJ, Regel G. Effects of early enteral nutrition with arginine, omega-3-fatty acids and nucleotides supplemented on the systemic inflammatory response syndrome and immune function in severe multiple injury[J]. Clin-Nutr, 1996;15 (Suppl 1): 525.
23.	Jiang HP, Liu CA, Wang DA. Application of glutamine-combined with parenteral nutrition in the critically ill patients of general surgery[J]. Lingnan Mordern Clinics in Surgery;2004, 4 (1): 41-43.
24.	Moher D, MSc. The CONSORT Guidelines: improving the quality of research. Consolidated Standards of Reporting Trials. Interview by Bonnie Horrigan[J]. Altern Ther Health Med, 2002;8(3): 103-108.

1. 黄武, 刘幼硕. 谷氨酞胺强化的营养支持对老年SIRS的调理作用[J]. 肠外与肠内营养, 2002;9(4): 199～200.
2. 姜海平, 刘春安, 王大安. 谷氨酰胺强化肠外营养对普外科全身炎症反应综合征的影响[J]. 中国病理生理杂志, 2003;19(6): 847～848.
3. 刘幼硕, 龙利民, 屈晓冰, 那日苏, 何福清. 不同热能PN对对老年全身炎症反应综合征的治疗研究[J]. 湖南医科大学学报, 2000;25(3): 251～253.
4. 刘幼硕, 屈晓冰, 庞新利, 杨川. 应用合理热能肠外营养治疗高龄病人全身炎症反应综合征[J]. 肠外与肠内营养, 2000;7(2);63～66.
5. 姜海平, 刘春安, 王大安. 肠外营养联合谷氨酰胺在普外可危重病人的应用[J]. 岭南现代外科, 2004;4(1): 41～43.
6. Bone RC, Balk RA, Cerra FB. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis[J]. Chest, 1992;101(6): 1 028.
7. Hirasawa H, Sugai T, Ohtake Y, Oda S, Matsuda K, Kitamura N. Blood purification for prevention and treatment of multiple organ failure[J]. World J Surg, 1996;20(4): 482-486.
8. Neoshol me EA, Callder PC. The proposed role of glutamine in some cells of the immune system and speculative consequences for the whole animal[J]. Nutrition, 1997;13(7-8): 728-730.
9. Juni P, Altman DG, Eger M. Assessing the quality of controlled clinical trials[J]. BMJ, 2001;323(7 303): 42-46.
10. Huang W, Liu YS. The efficacy of glutamine-intensified nutrition support on systemic inflammatory response syndrome in the elderly[J]. Parenteral & Enteral Nutrition, 2002;9 (4): 199-200.
11. Conejero R, Bonet A, Grau T, Esteban A, Mesejo A, Montejo JC, Lopez J, Acosta JA. Effect of a glutamine-enriched enteral diet on intestinal permeability and infectious morbidity at 28 days in critically ill patients with systemic inflammatory response syndrome: a randomized, single-blind, prospective, multicenter study[J]. Nutrition, 2002;18(9): 716-721.
12. Jiang HP, Liu CA, Wang DA. Effect of glutamine-combined with parenteral nutrition in systematic inflammatory response syndrome patients of general surgery[J]. Chinese Journal of Pathophysiology, 2003;19 (6): 847-848.
13. Liu YS, Long LM, Qu XB, Na RS, He FQ. The efficacy of parenteral nutrition with different energy for systemic inflammatory response syndrome (SIRS) in the aged[J]. Bulletin of Hunan Medical University, 2000;25(3): 251-253.
14. Angstwurm, Matthias WA, Schottdorf, Juergen MS, Schopohl, Jochen MD;Gaertner, Roland. Selenium replacement in patients with severe systemic inflammatory response syndrome improves clinical outcome[J]. Critical Care Medicine, 1999;27(9): 1 807-1 813.
15. Lopez Martinez J, Sanchez Castilla M, de Juana Velasco P, Diaz Abad R, Rodriguez Roldan JM, Garcia de Lorenzo y Mateos A, Del Nogal Saez F. Non-glucose carbohydrates in the parenteral nutrition of patients with systemic inflammatory response syndrome[J]. Nutricion Hospitalaria, 1999;14 (2):71-80.
16. Weimann A, Bastian L, Bischoff WE, Grotz M, Hansel M, Lotz J, Trautwein C, Tusch G, Schlitt HJ, Regel G. Influence of arginine, omega-3 fatty acids and nucleotide-supplemented enteral support on systemic inflammatory response syndrome and multiple organ failure in patients after severe trauma[J]. Nutrition,1998;14 (2): 165-172.
17. Bastian L, Weimann A, Regel G, Tscherne H. Is modification of systemic inflammatory response syndrome and multiple organ failure by parenteral feeding possible[J]? Langenbecks Archiv fur Chirurgie-Supplement-Kongressband, 1998;115: 1 083-1 085.
18. Cerra FB, McPherson JP, Konstantinides FN, Konstantinides NN, Teasley KM. Enteral nutrition does not prevent multiple organ failure syndrome (MOFS) after sepsis[J]. Surgery, 1988 ;104(4): 727-733.
19. Bower RH, Cerra FB, Bershadsky B, Licari JJ, Hoyt DB, Jensen GL, Van Buren CT, Rothkopf MM, Daly JM, Adelsberg BR. Early enteral administration of a formula (Impact) supplemented with arginine, nucleotides, and fish oil in intensive care unit patients: results of a multicenter, prospective, randomized, clinical trial [J]. Critical Care Medicine, 1995;23(3): 436-449.
20. Liu YS, Qu XB, Pang XL, Yang C. A study on suitable energy of parenteral nutrition with for octogenarian patients with systemic inflammatory response syndrome [J]. Parenteral & Enteral Nutrition, 2000;7 (2): 63-66.
21. Weimann A, Bastian L, Bischoff WE, Grotz M, BodeBoger S, Hansel M, Lotz J, Regel G. The influence of enteral nutrition with arginine, omega 3 fatty acids and nucleotides supplemented diet of systemic inflammatory response syndrome in severe multiple injury[J]. Intensive Care Medicine, 1996;2 (Suppl 3): s353.
22. Weimann A, Bastian L, Grotz M, Hansel M, Schlitt HJ, Regel G. Effects of early enteral nutrition with arginine, omega-3-fatty acids and nucleotides supplemented on the systemic inflammatory response syndrome and immune function in severe multiple injury[J]. Clin-Nutr, 1996;15 (Suppl 1): 525.
23. Jiang HP, Liu CA, Wang DA. Application of glutamine-combined with parenteral nutrition in the critically ill patients of general surgery[J]. Lingnan Mordern Clinics in Surgery;2004, 4 (1): 41-43.
24. Moher D, MSc. The CONSORT Guidelines: improving the quality of research. Consolidated Standards of Reporting Trials. Interview by Bonnie Horrigan[J]. Altern Ther Health Med, 2002;8(3): 103-108.

Chinese Journal of Evidence-Based Medicine

Effect of Clinical Nutritional Supplementation for Systematic Inflammatory Response Syndrome: A Systematic Review

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