Efficacy of dietary supplements on mortality and clinical outcomes in adults with sepsis and septic shock: A systematic review and network meta-analysis.
Study Goal
The researchers aimed to investigate the effects of dietary supplements, including antioxidants, on mortality and clinical outcomes in adults with sepsis.
Results Summary
The study found that a combination of eicosapentaenoic acid, gamma-linolenic acid, and antioxidants (EPA + GLA + AOs) was the most effective in reducing mechanical ventilation duration and ICU length of stay, though no dietary supplement significantly impacted hospital stay. Antioxidants alone were not highlighted for mortality benefits, except in combination with other supplements.
Population
Adults suffering from sepsis or septic shock.
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
magnesium | decrease | short-term mortality | adults with sepsis | RR: 0.33, 95% CI: 0.14, 0.79 | had beneficial effects | #1 |
vitamin C | decrease | short-term mortality | adults with sepsis | RR: 0.81, 95% CI: 0.67, 0.99 | had beneficial effects | #2 |
eicosapentaenoic acid, gamma-linolenic acid, and antioxidants (EPA + GLA + AOs) combination | decrease | duration of mechanical ventilation | adults with sepsis | - | was the most effective | #3 |
eicosapentaenoic acid, gamma-linolenic acid, and antioxidants (EPA + GLA + AOs) combination | decrease | ICU length of stay | adults with sepsis | - | was the most effective | #4 |
magnesium | decrease | duration of mechanical ventilation | adults with sepsis | - | was effective | #5 |
magnesium | decrease | ICU length of stay | adults with sepsis | - | was effective | #6 |
vitamin D | decrease | duration of mechanical ventilation | adults with sepsis | - | was effective | #7 |
vitamin D | decrease | ICU length of stay | adults with sepsis | - | was effective | #8 |
vitamin C | decrease | duration of mechanical ventilation | adults with sepsis | - | was effective | #9 |
vitamin C | decrease | ICU length of stay | adults with sepsis | - | was effective | #10 |
- | no change | hospital stay | adults with sepsis | - | no beneficial dietary supplement | #11 |
- | no change | short-term mortality | adults with sepsis | - | no treatment more effective | #12 |
- | no change | long-term mortality | adults with sepsis | - | no treatment more effective | #13 |
AIM: The aim of this network meta-analysis (NMA) was to investigate the effects of different dietary supplements on the mortality and clinical status of adults with sepsis. METHODS: We searched PubMed, EMBASE, and the Cochrane Library Central Register of Controlled Trials until February 2023. The inclusion criteria were: 1) randomized controlled trials (RCT)s; 2) adults suffering sepsis or septic shock; 3) evaluation of short- or long-mortality; and 4) publications between 1994 and 2023. The general information of studies and details of interventions were extracted. The primary outcome was short-term mortality (<90 days), and the secondary outcomes were long-term mortality (≥90 days), length of ICU and hospital stays, and duration of mechanical ventilation (MV). The risk of bias of RCTs was assessed using the Cochrane risk of bias tool 2 (ROB2). A random effect NMA was performed to rank the effect of each intervention using a frequentist approach. RESULTS: Finally, 56 RCTs with 5957 participants met the criteria. Approximately, one-third of RCTs were low risk of bias. NMA analysis revealed that there was no treatment more effective in short- or long-term mortality than control or other interventions, except for magnesium (RR: 0.33, 95% CI: 0.14, 0.79; GRADE = low) and vitamin C (RR: 0.81, 95% CI: 0.67, 0.99; low certainty evidence), which had beneficial effects on short-term mortality. Moreover, eicosapentaenoic acid, gamma-linolenic acid, and antioxidants (EPA + GLA + AOs) combination was the most effective, and magnesium, vitamin D and vitamin C were the other effective approaches in terms of duration of MV, and ICU length of stay. There was no beneficial dietary supplement for hospital stay in these patients. CONCLUSIONS: In septic patients, none of the dietary supplements had a substantial effect on mortality except for magnesium and vitamin C, which were linked to lower short-term mortality with low certainty of evidence. Further investigation into high-quality studies with the use of dietary supplements for sepsis should be highly discouraged.