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. 2017 Dec;7(1):58.
doi: 10.1186/s13613-017-0282-5. Epub 2017 Jun 5.

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

Clara Lu  1 , Sunjay Sharma  2 , Lauralyn McIntyre  3 , Andrew Rhodes  4 , Laura Evans  5 , Saleh Almenawer  2 , Lori Leduc  6 , Derek C Angus  7 , Waleed Alhazzani  8   9   10
Affiliations

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

Clara Lu et al. Ann Intensive Care. 2017 Dec.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Critical illness; DHA; EPA; Fish oil; ICU; Nutrition; Omega-3; PUFA; Sepsis.

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Figures

Fig. 1
Fig. 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart: description of the study selection process. Seventeen trials (1 abstract and 16 fully published trials) were eligible and included in the qualitative and quantitative analyses. ICU, intensive care unit
Fig. 2
Fig. 2
Risk of bias assessment of the included trials using the Cochrane Collaboration tool. Individual risk of bias assessments across seven domains: random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective reporting, and other bias. Risk of bias levels: low (green), unclear (yellow), high (red)
Fig. 3
Fig. 3
Mortality outcome. Data from 17 trials (n = 1239 patients) were included and analysed using the random-effects model. Omega-3 supplementation was associated with a non-significant reduction in mortality. ICU intensive care unit, IV inverse variance, RCT randomized clinical trial
Fig. 4
Fig. 4
ICU length of stay outcome. Data from 12 trials (n = 925 patients) were included and analysed using the random-effects model. Omega-3 supplementation was associated with a significantly lower length of stay in ICU. IV inverse variance
Fig. 5
Fig. 5
Duration of mechanical ventilation outcome. Data from 7 trials (n = 495 patients) were included and analysed using the random-effects model. Omega-3 supplementation was associated with a significantly shorter duration of mechanical ventilation. IV inverse variance
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