| Title |
Glutamine, fish oil and antioxidants in critical illness: MetaPlus trial post hoc safety analysis
|
|---|---|
| Published in |
Annals of Intensive Care, December 2016
|
| DOI | 10.1186/s13613-016-0220-y |
| Pubmed ID | |
| Authors |
Zandrie Hofman, Sophie Swinkels, Arthur R. H. van Zanten |
| Abstract |
The role of plasma glutamine, fish oil and antioxidants concentrations in the treatment effect of immune-modulating high-protein versus high-protein enteral nutrition on 6-month mortality in critically ill patients is explored, as unexpected negative outcomes of recent large randomized controlled trials on immune-modulating nutrients have raised questions about safety of these interventions. Post hoc analysis of the MetaPlus randomized controlled trial which was performed in a total of 301 medical, surgical and trauma critically ill patients in fourteen European intensive care units. Patients received either immune-modulating (glutamine, fish oil and antioxidant enriched) high-protein (IMHP) or isocaloric high-protein (HP) enteral nutrition. Six-month mortality and baseline, day 4 and day 8 plasma concentrations of glutamine, (eicosapentaenoicacid + decosahexaenoicacid)/long-chain fatty acid plasma level ratio ((epa + dha)/lcf ratio), selenium, vitamin c, vitamin e and zinc were measured. The harmful treatment effect of the IMHP versus HP enteral nutrition on 6-month mortality was only demonstrated in the medical subgroup (HR 2.52, 95% CI 1.36-4.78, P = 0.004). Among medical patients, when corrected for age groups and APACHE-II scores, there were no statistically significant associations between baseline plasma levels and 6-month mortality, except for zinc (HR 1.06, 95% CI 1.00-1.12, P = 0.026). IMHP feeding resulted in statistically significant increase in plasma levels of glutamine, vitamin e, vitamin c and (epa + dha)/lcf ratio from baseline to day 4, while only the change from baseline to day 4 of (epa + dha)/lcf ratio was statistically significant associated with 6-month mortality (HR 1.18, 95% CI 1.02-1.35, P = 0.021) and identified as mediator for the harmful treatment effect of IMHP enteral nutrition among medical ICU patients. We hypothesize that the harmful effect of IMHP compared to HP enteral nutrition in a heterogeneous group of critically ill patients is limited to the medical critically ill patients and mediated by an early increase in (epa + dha)/lcf ratio. Trial Registration Dutch Trial Register 26 January 2010 (NTR2181 http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2181 ). |
X Demographics
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Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 1 | 100% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 1 | 100% |
Mendeley readers
The data shown below were compiled from readership statistics for 66 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 66 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Master | 12 | 18% |
| Researcher | 8 | 12% |
| Student > Bachelor | 6 | 9% |
| Student > Postgraduate | 6 | 9% |
| Other | 5 | 8% |
| Other | 12 | 18% |
| Unknown | 17 | 26% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 26 | 39% |
| Nursing and Health Professions | 9 | 14% |
| Pharmacology, Toxicology and Pharmaceutical Science | 2 | 3% |
| Agricultural and Biological Sciences | 2 | 3% |
| Biochemistry, Genetics and Molecular Biology | 2 | 3% |
| Other | 2 | 3% |
| Unknown | 23 | 35% |
Attention Score in Context
This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 18 December 2016.
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#20,656,820
of 25,374,647 outputs
Outputs from Annals of Intensive Care
#1,054
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#317,291
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Outputs of similar age from Annals of Intensive Care
#18
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