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Meta-Analysis
. 2015 Aug;94(31):e1319.
doi: 10.1097/MD.0000000000001319.

Glutamine Supplementation in Intensive Care Patients: A Meta-Analysis of Randomized Clinical Trials

Massimo Oldani  1 , Marta Sandini, Luca Nespoli, Sara Coppola, Davide Paolo Bernasconi, Luca Gianotti
Affiliations
Meta-Analysis

Glutamine Supplementation in Intensive Care Patients: A Meta-Analysis of Randomized Clinical Trials

Massimo Oldani et al. Medicine (Baltimore). 2015 Aug.

Abstract

The role of glutamine (GLN) supplementation in critically ill patients is controversial. Our aim was to analyze its potential effect in patients admitted to intensive care unit (ICU).We performed a systematic literature review through Medline, Embase, Pubmed, Scopus, Ovid, ISI Web of Science, and the Cochrane-Controlled Trials Register searching for randomized clinical trials (RCTs) published from 1983 to 2014 and comparing GLN supplementation to no supplementation in patients admitted to ICU. A random-effect meta-analysis for each outcome (hospital and ICU mortality and rate of infections) of interest was carried out. The effect size was estimated by the risk ratio (RR).Thirty RCTs were analyzed with a total of 3696 patients, 1825 (49.4%) receiving GLN and 1859 (50.6%) no GLN (control groups). Hospital mortality rate was 27.6% in the GLN patients and 28.6% in controls with an RR of 0.93 (95% CI = 0.81-1.07; P = 0.325, I = 10.7%). ICU mortality was 18.0 % in the patients receiving GLN and 17.6% in controls with an RR of 1.01 (95% CI = 0.86-1.19; P = 0.932, I = 0%). The incidence of infections was 39.7% in GLN group versus 41.7% in controls. The effect of GLN was not significant (RR = 0.88; 95% CI = 0.76-1.03; P = 0.108, I = 56.1%).These results do not allow to recommend GLN supplementation in a generic population of critically ills. Further RCTs are needed to explore the effect of GLN in more specific cohort of patients.

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Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Flow diagram of the literature search according to the PRISMA statement.
FIGURE 2
FIGURE 2
Forest plot of the effect of GLN supplementation on in-hospital mortality. Size of squares for RR reflects the weight of the trial in the pooled analyses. Horizontal bars 95 % CI. CI = confidence intervals, GLN = glutamine, RR = relative risk.
FIGURE 3
FIGURE 3
Funnel plots for (A) overall mortality, (B) intensive care unit (ICU) mortality, (C) infectious morbidity, (D) length of stay, and (E) ICU length of stay.
FIGURE 4
FIGURE 4
Forest plot of the effect of GLN supplementation on ICU mortality. Size of squares for RR reflects the weight of the trial in the pooled analyses. Horizontal bars 95% CI. CI = confidence intervals, GLN = glutamine, ICU = intensive care unit, RR = relative risk.
FIGURE 5
FIGURE 5
Forest plot of the effect of GLN supplementation on infectious morbidity. Size of squares for RR reflects the weight of the trial in the pooled analyses. Horizontal bars 95 % CI. CI = confidence intervals, GLN = glutamine, RR = relative risk.
FIGURE 6
FIGURE 6
Forest plots of the effect of GLN on (A) hospital length of stay and (B) ICU length of stay comparing GLN and control. Size of squares for MD reflects the weight of the trial in the pooled analyses. Horizontal bars 95% CI. CI = confidence intervals, GLN = glutamine, ICU = intensive care unit, MD = mean difference, RR = relative risk
See this image and copyright information in PMC

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