Effect Of Clinical Nutritional Supplementation For Systematic Inflammatory Response Syndrome: A Systematic Review

Objective: To assess the efficacy and safety of clinical nutritional supplementation with different patterns for treating systematic inflammatory response syndrome (SIRS). Method : Randomized controlled trails (RCTs) were identified from MEDLINE(1996-2004.11), EMBASE(1984 - 2002.11). Cochrane Controlled Trails Register, (CCTR, Issue 4, 2004), Chinese Cochrane Centre Database (CCCD, Issue 4, 2004), CBM (1978-2004.11), we handsearched related published and unpublished data and their references.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. (1) All studies for neither glutamine versus routine nutrition nor selenium versus no treatment have statistical significant benefit on reducing the rate of death caused from SIRS [RR 1.19, 95% CI (0.59,2.41) and RR 0.64,95% CI (0.31,1.32), respectively]; (2) There was a statistical significant benefit on reducing the ratio of nosocomial infection of SIRS by giving glutamine versus routine nutrition [RR 0.5, 95% CI (0.27, 1.32)], but there was no same effect on reducing the ratio of MODS complication [RR 1.53, 95% CI (0.64, 3.66)]; (3) Either glutamine versus routine nutrition or low calorie intake versus high calorie intake shown a statistical significant improvement of thecritical condition of SIRS [WMD 4.0, 95% CI (2.36, 5.64)]; ? There was statistical significant on reducing the complication of hyperglycemia and hypertriglyceridemia at the comparison of low calorie intake versus high calorie intake [WMD -0.70, 95% CI (-1.20, -0.20), and WMD -1.80, 95% CI (-2.42, -1.18)] FGX mixture versus glucose and carbohydrates (P<0.01) (5) There was a statistical significant increasing of plasma IgG concentration by comparison of glutamine versus routine nutrition [WMD 4.20, 95% CI (2.23, 6.16)]; ? Neither glutamine, low calorie intake, selenium supplementation, FGX mixture shown benefit on increasing the nitrogen balance or intestinal permeability or the level of plasma concentration of albumin, prealbumin, TRF, etc, than control. Conclusion: Glutamine, low calorie intake, selenium supplementation, FGX mixture may decrease the complication of infection or metabolism or APACHE II scores 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. There are deficiencies in strict randomization, allocation concealment, blinding, and follow-up. More high quality trails are required.