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Cited by 69Clinical Nutrition and GastroenterologySepsis Diagnosis and TreatmentHyperglycemia and glycemic control in critically ill and hospitalized patients

Omega-3 supplementation in patients with sepsis: a systematic review and meta-analysis of randomized trials

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Lu, Clara, Sharma, Sunjay, McIntyre, Lauralyn, Rhodes, Andrew, Evans, Laura, Almenawer, Saleh, Leduc, Lori, Angus, Derek C. +1 more·2017·Annals of Intensive Care
DOI 10.1186/s13613-017-0282-5PMC PMC5459780
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Abstract

Nutritional supplementation of omega-3 fatty acids has been proposed to modulate the balance of pro- and anti-inflammatory mediators in sepsis. If proved to improve clinical outcomes in critically ill patients with sepsis, this intervention would be easy to implement. However, the cumulative evidence from several randomized clinical trials (RCTs) remains unclear. We searched the Cochrane Library, MEDLINE, and EMBASE through December 2016 for RCTs on parenteral or enteral omega-3 supplementation in adult critically ill patients diagnosed with sepsis or septic shock. We analysed the included studies for mortality, intensive care unit (ICU) length of stay, and duration of mechanical ventilation, and used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the quality of the evidence for each outcome. A total of 17 RCTs enrolling 1239 patients met our inclusion criteria. Omega-3 supplementation compared to no supplementation or placebo had no significant effect on mortality [relative risk (RR) 0.85; 95% confidence interval (CI) 0.71, 1.03; P = 0.10; I 2 = 0%; moderate quality], but significantly reduced ICU length of stay [mean difference (MD) −3.79 days; 95% CI −5.49, −2.09; P < 0.0001, I 2 = 82%; very low quality] and duration of mechanical ventilation (MD −2.27 days; 95% CI −4.27, −0.27; P = 0.03, I 2 = 60%; very low quality). However, sensitivity analyses challenged the robustness of these results. Omega-3 nutritional supplementation may reduce ICU length of stay and duration of mechanical ventilation without significantly affecting mortality, but the very low quality of overall evidence is insufficient to justify the routine use of omega-3 fatty acids in the management of sepsis.

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  • Meta-analyses by Palmer et al., Chen et al., Pradelli et al., Manzanares et al. and Zhu et al. showed a decrease in length of stay.

    “Those of Palmer et al. (267), Chen et al. (268), Pradelli et al. (269), Manzanares et al. (270) and Zhu et al. (271) showed a decrease in length of stay, while Manzanares et al. (270) and Zhu et al. (271) also showed a decrease in infections.”

    From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [269]

    The Results > Main outcomes (page unavailable) report that Lu et al.'s meta-analysis found a significant reduction in ICU length of stay with omega-3 supplementation in patients with sepsis. That supports the direction of the length-of-stay finding, but it does not establish that each of the five named meta-analyses found a decrease. The Results > Subgroup and sensitivity analyses also report that the ICU finding became non-significant when trials lacking explicit blinding were excluded. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Lu et al. analyzed 17 RCTs of enteral and parenteral ω-3 PUFA administration in 1239 patients with sepsis or septic shock; compared to no supplementation or placebo, ω-3 supplementation did not influence mortality but reduced ICU length of stay and duration of mechanical ventilation.

    “Compared to no supplementation or placebo, ω-3 supplementation did not influence mortality but reduced ICU length of stay and duration of mechanical ventilation [65].”

    From Nutrition in Sepsis: A Bench-to-Bedside Review. (2020) · cites this paper as [65]

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Cited by

Sorted by citations

Authors
Lu, C., Sharma, S., McIntyre, L., Rhodes, A., Evans, L., Almenawer, S., Leduc, L., Angus, D. C., & Alhazzani, W.
Affiliations
  • McMaster University (CA)
  • University of Ottawa (CA)
  • St George's Hospital (GB)
  • New York University (US)
  • St. Joseph’s Healthcare Hamilton (CA)
  • University of Pittsburgh (US)
Corresponding author
Alhazzani, Waleed
ORCID
Venue
Annals of Intensive Care
Publisher
Elsevier BV
Published
2017
Volume
7
Issue
1
Pages
58
ISSN
2110-5820 (ISSN-L)
DOI
10.1186/s13613-017-0282-5
PMC
PMC5459780
OpenAlex
W2623612217
Cited by
69
References
6
Citations by year
2026: 4 · 2025: 6 · 2024: 6 · 2023: 5 · 2022: 3 · 2021: 10 · 2020: 15 · 2019: 7 · 2018: 11 · 2017: 2
FWCI
0.98
Type
journal article
Language
en
Open access
Licence
Locations
  • Annals of Intensive Care (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • St George's Online Research Archive (St George's University of London) (acceptedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
Keywords
omega-3 fatty acids, sepsis, septic shock, dietary supplementation, critically ill patients, mortality, ICU length of stay, mechanical ventilation duration, parenteral nutrition, enteral nutrition, anti-inflammatory activity

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