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Clin Nutr. 2013 Apr;32(2):213-23. doi: 10.1016/j.clnu.2012.11.003. Epub 2012 Nov 9.

A systematic literature review and meta-analysis of randomized clinical trials of parenteral glutamine supplementation.

Author information

1
Institute of Social and Preventive Medicine, Medical Economics Unit, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland. lea.bollhalder@ifspm.uzh.ch

Abstract

BACKGROUND & AIMS:

Glutamine supplementation has been associated with reduced mortality, infections and hospital length of stay in critically ill patients and patients undergoing major surgery. We carried out a meta-analysis to examine randomized clinical trial (RCT)-based evidence of these effects.

METHODS:

Based on a systematic database search, RCTs published since 1990 were included if they evaluated the effect of parenteral glutamine supplementation against a background of parenteral nutrition. Enteral (tube) feeding in a proportion of patients was allowable. Information on RCT methodology, quality and outcomes was extracted. Random effects meta-analysis followed the DerSimonian-Laird approach.

RESULTS:

Forty RCTs were eligible for meta-analysis. Parenteral glutamine supplementation was associated with a non-significant 11% reduction in short-term mortality (RR = 0.89; 95% CI, 0.77-1.04). Infections were significantly reduced (RR = 0.83; 95% CI, 0.72-0.95) and length of stay was 2.35 days shorter (95% CI, -3.68 to -1.02) in the glutamine arms. Meta-analysis results were strongly influenced by one recent trial. An element of publication bias could not be excluded.

CONCLUSION:

Parenteral glutamine supplementation in severely ill patients may reduce infections, length of stay and mortality, but substantial uncertainty remains. Unlike previous meta-analyses, we could not demonstrate a significant reduction in mortality.

PMID:
23196117
DOI:
10.1016/j.clnu.2012.11.003
[Indexed for MEDLINE]

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