November 12, 2014
Sarin, S K
Clin Radiol. 2014 Mar;69(3):299-306. doi: 10.1016/j.crad.2013.07.011. Epub 2013 Oct 3.
Author Address: Department of Radiology, Institute of Liver and Biliary Sciences, Delhi, India. Electronic address: email@example.com.
Department of Radiology, Institute of Liver and Biliary Sciences, Delhi, India.
Department of Hepatology and Gastroenterology, Institute of Liver and Biliary Sciences, Delhi, India.
Reference Type: Journal Article
Record Number: 4918Author: Asrani, V., Chang, W. K., Dong, Z., Hardy, G., Windsor, J. A. and Petrov, M. S.
Title: Glutamine supplementation in acute pancreatitis: a meta-analysis of randomized controlled trials
Short Title: Glutamine supplementation in acute pancreatitis: a meta-analysis of randomized controlled trials
Alternate Journal: Pancreatology : official journal of the International Association of Pancreatology
ISSN: 1424-3911 (Electronic)
Accession Number: 24075510
Keywords: Enteral Nutrition/methods
Length of Stay
Parenteral Nutrition, Total
Randomized Controlled Trials as Topic
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.