Glutamine supplementation in serious illness: a systematic review of the evidence

F. Novak, D. K. Heyland, Alison Avenell, J. W. Drover, X. Su

Research output: Contribution to journalArticle

587 Citations (Scopus)

Abstract

Objective. To examine the relationship between glutamine supplementation and hospital length of stay, complication rates, and mortality in patients undergoing surgery and experiencing critical illness.

Data Sources. Computerized search of electronic databases and search of personal files, abstract proceedings, relevant journals, and review of reference lists.

Study Selection: We reviewed 550 titles, abstracts, and articles. Primary studies were included if they were randomized trials of critically ill or surgical patients that evaluated the effect of glutamine vs. standard care on clinical outcomes.

Data Extraction: We abstracted relevant data on the methodology and outcomes of primary studies in duplicate, independently.

Data Synthesis. There were 14 randomized trials comparing the use of glutamine supplementation in surgical and critically ill patients. When the results of these trials were aggregated, with respect to mortality, glutamine supplementation was associated with a risk ratio (RR) of 0.78 (95% confidence interval [Cl], 0.58-1.04). Glutamine supplementation was also associated with a lower rate of infectious complications (RR, 0.81; 95% Cl, 0.64-1.00) and a shorter hospital stay (-2.6 days; 95% Cl, -4.5 to -0.7). We examined several a priori-specified subgroups. Although there were no statistically significant subgroup differences detected, there were some important trends. With respect to mortality, the treatment benefit was observed in studies of parenteral glutamine (RR, 0.71; 95% Cl, 0.51-0.99) and high-dose glutamine (RR, 0.73; 95% Cl, 0.53-1.00) compared with studies of enteral glutamine (RR, 1.08; 95% Cl, 0.57-2.01) and low-dose glutamine (RR, 1.02; 95% Cl, 0.52-2.00). With respect to hospital length of stay, all of the treatment benefit was observed in surgical patients (-3.5 days; 95% Cl, -5.3 to -1.7) compared with critically ill patients (0.9 days; 95% Cl, -4.9 to 6.8).

Conclusion: In surgical patients, glutamine. supplementation may be associated with a reduction in infectious complication rates and shorter hospital stay without any adverse effect on mortality. In critically ill patients, glutamine supplementation may be associated with a reduction in complication and mortality rates. The greatest benefit was observed in patients receiving high-dose, parenteral glutamine.

Original languageEnglish
Pages (from-to)2022-2029
Number of pages7
JournalCritical Care Medicine
Volume30
Issue number9
DOIs
Publication statusPublished - 2002

Keywords

  • glutamine
  • enteral nutrition
  • critical care
  • surgery
  • cross infections
  • pneumonia
  • review
  • meta-analysis
  • randomized trials
  • TOTAL PARENTERAL-NUTRITION
  • CRITICALLY ILL PATIENTS
  • MAJOR ABDOMINAL-SURGERY
  • DOUBLE-BLIND
  • ALANYL-GLUTAMINE
  • BACTERIAL TRANSLOCATION
  • PLASMA GLUTAMINE
  • CLINICAL-TRIALS
  • INTESTINAL PERMEABILITY
  • IMPROVES SURVIVAL

Cite this

Glutamine supplementation in serious illness: a systematic review of the evidence. / Novak, F.; Heyland, D. K.; Avenell, Alison; Drover, J. W.; Su, X.

In: Critical Care Medicine, Vol. 30, No. 9, 2002, p. 2022-2029.

Research output: Contribution to journalArticle

Novak, F. ; Heyland, D. K. ; Avenell, Alison ; Drover, J. W. ; Su, X. / Glutamine supplementation in serious illness: a systematic review of the evidence. In: Critical Care Medicine. 2002 ; Vol. 30, No. 9. pp. 2022-2029.
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T1 - Glutamine supplementation in serious illness: a systematic review of the evidence

AU - Novak, F.

AU - Heyland, D. K.

AU - Avenell, Alison

AU - Drover, J. W.

AU - Su, X.

PY - 2002

Y1 - 2002

N2 - Objective. To examine the relationship between glutamine supplementation and hospital length of stay, complication rates, and mortality in patients undergoing surgery and experiencing critical illness.Data Sources. Computerized search of electronic databases and search of personal files, abstract proceedings, relevant journals, and review of reference lists.Study Selection: We reviewed 550 titles, abstracts, and articles. Primary studies were included if they were randomized trials of critically ill or surgical patients that evaluated the effect of glutamine vs. standard care on clinical outcomes.Data Extraction: We abstracted relevant data on the methodology and outcomes of primary studies in duplicate, independently.Data Synthesis. There were 14 randomized trials comparing the use of glutamine supplementation in surgical and critically ill patients. When the results of these trials were aggregated, with respect to mortality, glutamine supplementation was associated with a risk ratio (RR) of 0.78 (95% confidence interval [Cl], 0.58-1.04). Glutamine supplementation was also associated with a lower rate of infectious complications (RR, 0.81; 95% Cl, 0.64-1.00) and a shorter hospital stay (-2.6 days; 95% Cl, -4.5 to -0.7). We examined several a priori-specified subgroups. Although there were no statistically significant subgroup differences detected, there were some important trends. With respect to mortality, the treatment benefit was observed in studies of parenteral glutamine (RR, 0.71; 95% Cl, 0.51-0.99) and high-dose glutamine (RR, 0.73; 95% Cl, 0.53-1.00) compared with studies of enteral glutamine (RR, 1.08; 95% Cl, 0.57-2.01) and low-dose glutamine (RR, 1.02; 95% Cl, 0.52-2.00). With respect to hospital length of stay, all of the treatment benefit was observed in surgical patients (-3.5 days; 95% Cl, -5.3 to -1.7) compared with critically ill patients (0.9 days; 95% Cl, -4.9 to 6.8).Conclusion: In surgical patients, glutamine. supplementation may be associated with a reduction in infectious complication rates and shorter hospital stay without any adverse effect on mortality. In critically ill patients, glutamine supplementation may be associated with a reduction in complication and mortality rates. The greatest benefit was observed in patients receiving high-dose, parenteral glutamine.

AB - Objective. To examine the relationship between glutamine supplementation and hospital length of stay, complication rates, and mortality in patients undergoing surgery and experiencing critical illness.Data Sources. Computerized search of electronic databases and search of personal files, abstract proceedings, relevant journals, and review of reference lists.Study Selection: We reviewed 550 titles, abstracts, and articles. Primary studies were included if they were randomized trials of critically ill or surgical patients that evaluated the effect of glutamine vs. standard care on clinical outcomes.Data Extraction: We abstracted relevant data on the methodology and outcomes of primary studies in duplicate, independently.Data Synthesis. There were 14 randomized trials comparing the use of glutamine supplementation in surgical and critically ill patients. When the results of these trials were aggregated, with respect to mortality, glutamine supplementation was associated with a risk ratio (RR) of 0.78 (95% confidence interval [Cl], 0.58-1.04). Glutamine supplementation was also associated with a lower rate of infectious complications (RR, 0.81; 95% Cl, 0.64-1.00) and a shorter hospital stay (-2.6 days; 95% Cl, -4.5 to -0.7). We examined several a priori-specified subgroups. Although there were no statistically significant subgroup differences detected, there were some important trends. With respect to mortality, the treatment benefit was observed in studies of parenteral glutamine (RR, 0.71; 95% Cl, 0.51-0.99) and high-dose glutamine (RR, 0.73; 95% Cl, 0.53-1.00) compared with studies of enteral glutamine (RR, 1.08; 95% Cl, 0.57-2.01) and low-dose glutamine (RR, 1.02; 95% Cl, 0.52-2.00). With respect to hospital length of stay, all of the treatment benefit was observed in surgical patients (-3.5 days; 95% Cl, -5.3 to -1.7) compared with critically ill patients (0.9 days; 95% Cl, -4.9 to 6.8).Conclusion: In surgical patients, glutamine. supplementation may be associated with a reduction in infectious complication rates and shorter hospital stay without any adverse effect on mortality. In critically ill patients, glutamine supplementation may be associated with a reduction in complication and mortality rates. The greatest benefit was observed in patients receiving high-dose, parenteral glutamine.

KW - glutamine

KW - enteral nutrition

KW - critical care

KW - surgery

KW - cross infections

KW - pneumonia

KW - review

KW - meta-analysis

KW - randomized trials

KW - TOTAL PARENTERAL-NUTRITION

KW - CRITICALLY ILL PATIENTS

KW - MAJOR ABDOMINAL-SURGERY

KW - DOUBLE-BLIND

KW - ALANYL-GLUTAMINE

KW - BACTERIAL TRANSLOCATION

KW - PLASMA GLUTAMINE

KW - CLINICAL-TRIALS

KW - INTESTINAL PERMEABILITY

KW - IMPROVES SURVIVAL

U2 - 10.1097/00003246-200209000-00011

DO - 10.1097/00003246-200209000-00011

M3 - Article

VL - 30

SP - 2022

EP - 2029

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

IS - 9

ER -