Single‑blinded, randomized, and controlled clinical trial evaluating the effects of Omega‑3 fatty acids among septic patients with intestinal dysfunction: A pilot study

Chen,Huaisheng; Wang,Wei; Hong,Yingcai; Zhang,Huadong; Hong,Chengying; Liu,Xueyan

doi:10.3892/etm.2017.4680

Single‑blinded, randomized, and controlled clinical trial evaluating the effects of Omega‑3 fatty acids among septic patients with intestinal dysfunction: A pilot study

Authors:
- Huaisheng Chen
- Wei Wang
- Yingcai Hong
- Huadong Zhang
- Chengying Hong
- Xueyan Liu
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Affiliations: Intensive Care Unit, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen, Guangdong 518020, P.R. China
Published online on: June 27, 2017 https://doi.org/10.3892/etm.2017.4680
Pages: 1505-1511
Copyright: © Chen et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Sepsis is a systemic inflammatory reaction, which is aggravated by aspects of the immune response that are thought to be inhibited by Omega‑3 fatty acids. The aim of the present study was to determine if Omega‑3 fatty acid could modulate immunological function and improve survival rate among septic patients with intestinal dysfunction. A total of 48 mechanically ventilated patients with intestinal dysfunction were included in this prospective, randomized and single‑blind clinical study. Patients were randomly divided into control (group A) and treatment groups (group B). The treatment protocol for all the participants followed the Sepsis Survival Campaign guidelines, and group B received total parenteral nutrition containing 100 ml of Omega‑3 fatty acids (containing 10 g refined fish oil) per day in addition to the standard treatment applied in group A. Group B had a significantly lower mortality rate compared with group A (12.5 vs. 41.7%, P<0.05) during the 28‑day follow‑up. Group B also had lower Acute Physiology and Chronic Health Evaluation II scores (P<0.05) and lower Marshall scores (P<0.05) at day 7. In addition, group B had a higher ratio of T helper to inducer lymphocytes as well as a higher ratio of CD4 to CD8 lymphocytes (P<0.01 for both) than group A. It was concluded that Omega‑3 fatty acids improved T helper/inducer and CD4/CD8 ratios, and may have reduced mortality, among septic patients with intestinal dysfunction.

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1	Hotchkiss RS and Karl IE: The pathophysiology and treatment of sepsis. N Engl J Med. 348:138–150. 2003. View Article : Google Scholar : PubMed/NCBI
2	Hosny M, Nahas R, Ali S, Elshafei SA and Khaled H: Impact of oral omega-3 fatty acids supplementation in early sepsis on clinical outcome and immunomodulation. Egyptian J Crit Care Med. 1:119–126. 2013. View Article : Google Scholar
3	Tinsley KW, Grayson MH, Swanson PE, Drewry AM, Chang KC, Karl IE and Hotchkiss RS: Sepsis induces apoptosis and profound depletion of splenic interdigitating and follicular dendritic cells. J Immunol. 171:909–914. 2003. View Article : Google Scholar : PubMed/NCBI
4	Yu Y, Tian JH, Yang KH and Zhang P: Evaluation of efficacy of thymosin alpha1 in the treatment of sepsis: A systematic review. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 21:21–24. 2009.(In Chinese). PubMed/NCBI
5	Tugrul S, Ozcan PE, Akinci O, Seyhun Y, Cagatay A, Cakar N and Esen F: The effects of Igm-enriched immunoglobulin preparations in patients with severe sepsis [ISRCTN28863830]. Crit Care. 6:357–362. 2002. View Article : Google Scholar : PubMed/NCBI
6	Calder PC: Omega-3 fatty acids and inflammatory processes. Nutrients. 2:355–374. 2010. View Article : Google Scholar : PubMed/NCBI
7	Andersson A, Fenhammar J, Weitzberg E, Sollevi A, Hjelmqvist H and Frithiof R: Endothelin-mediated gut microcirculatory dysfunction during porcine endotoxaemia. Br J Anaesth. 105:640–647. 2010. View Article : Google Scholar : PubMed/NCBI
8	Martin JM and Stapleton RD: Omega-3 fatty acids in critical illness. Nutr Rev. 68:531–541. 2010. View Article : Google Scholar : PubMed/NCBI
9	Levy MM, Dellinger RP, Townsend SR, Linde-Zwirble WT, Marshall JC, Bion J, Schorr C, Artigas A, Ramsay G, Beale R, et al: The surviving sepsis campaign: Results of an international guideline-based performance improvement program targeting severe sepsis. Crit Care Med. 38:367–374. 2010. View Article : Google Scholar : PubMed/NCBI
10	Dong J, Zhang SW and Wang BE: Intestinal dysfunction and multiple organ dysfunction syndrome. Chin Crit Care Med. (issue 12): 764–767. 2005.(In Chinese).
11	Gillejohnson P, Hansson KE and Gårdlund B: Severe sepsis and systemic inflammatory response syndrome in emergency department patients with suspected severe infection. Scand J Infect Dis. 45:186–193. 2013. View Article : Google Scholar : PubMed/NCBI
12	Mori TA: Omega-3 fatty acids and cardiovascular disease: Epidemiology and effects on cardiometabolic risk factors. Food Funct. 5:2004–2019. 2014. View Article : Google Scholar : PubMed/NCBI
13	Simopoulos AP: The importance of the omega-6/omega-3 fatty acid ratio in cardiovascular disease and other chronic diseases. Exp Biol Med (Maywood). 233:674–688. 2008. View Article : Google Scholar : PubMed/NCBI
14	Shiramizo SC, Marra AR, Durão MS, Paes ÂT, Edmond MB and Pavão dos Santos OF: Decreasing mortality in severe sepsis and septic shock patients by implementing a sepsis bundle in a hospital setting. Plos One. 6:e267902011. View Article : Google Scholar : PubMed/NCBI
15	Barbalho SM, Rde A Goulart, Quesada K, Bechara MD and de Carvalho Ade C: Inflammatory bowel disease: Can omega-3 fatty acids really help? Ann Gastroenterol. 29:37–43. 2016.PubMed/NCBI
16	Fassett RG, Gobe GC, Peake JM and Coombes JS: Omega-3 polyunsaturated fatty acids in the treatment of kidney disease. Am J Kidney Dis. 56:728–742. 2010. View Article : Google Scholar : PubMed/NCBI
17	Heller AR, Rössel T, Gottschlich B, Tiebel O, Menschikowski M, Litz RJ, Zimmermann T and Koch T: Omega-3 fatty acids improve liver and pancreas function in postoperative cancer patients. Int J Cancer. 111:611–616. 2004. View Article : Google Scholar : PubMed/NCBI
18	Wohlmuth C, Dünser MW, Wurzinger B, Deutinger M, Ulmer H, Torgersen C, Schmittinger CA, Grander W and Hasibeder WR: Early fish oil supplementation and organ failure in patients with septic shock from abdominal infections: A propensity-matched cohort study. JPEN J Parenter Enteral Nutr. 34:431–437. 2010. View Article : Google Scholar : PubMed/NCBI
19	Li G, Li YS and Li JS: Acute bowel injury and acute intestinal distress syndrome: New concept of intestinal dysfunction. Chang Wai Yu Chang Nei Ying Yang. 17:302–305. 2010.
20	Carré JE and Singer M: Cellular energetic metabolism in sepsis: The need for a systems approach. Biochim Biophys Acta. 1777:763–771. 2008. View Article : Google Scholar : PubMed/NCBI
21	Huang S, Guan X, Chen J, Ou-yang B, Yang C and Chen M: The role of immunomodulation on immune function and prognosis in sepsis. Zhongguo Pu Tong Wai Ke Za Zhi. 1–931. 2009.
22	Huang S, Guan X, Chen J, Ou-yang B, Yang C and Liu Y: Immunomodulation effect on neutrophil leukocyte and lymphocyte subsets in septic rats. Zhonghua Pu Tong Wai Ke Xue Wen Xian. 3:362–365. 2009.
23	Wang YW, Field CJ and Sim JS: Dietary polyunsaturated fatty acids alter lymphocyte subset proportion and proliferation, serum immunoglobulin g concentration, and immune tissue development in chicks. Poult Sci. 79:1741–1748. 2000. View Article : Google Scholar : PubMed/NCBI
24	Grimble RF and Tappia PS: Modulation of pro-inflammatory cytokine biology by unsaturated fatty acids. Z Ernahrungswiss. 37 Suppl 1:S57–S65. 1998.
25	Hsu CS, Chiu WC, Yeh CL, Hou YC, Chou SY and Yeh SL: Dietary fish oil enhances adhesion molecule and interleukin-6 expression in mice with polymicrobial sepsis. Br J Nutr. 96:854–860. 2006. View Article : Google Scholar : PubMed/NCBI
26	Lopez-Garcia E, Schulze MB, Manson JE, Meigs JB, Albert CM, Rifai N, Willett WC and Hu FB: Consumption of (n-3) fatty acids is related to plasma biomarkers of inflammation and endothelial activation in women. J Nutr. 134:1806–1811. 2004.PubMed/NCBI
27	Guo L, Song Z, Li M, Wu Q, Wang D, Feng H, Bernard P, Daugherty A, Huang B and Li XA: Scavenger receptor bi protects against septic death through its role in modulating inflammatory response. J Biol Chem. 284:19826–19834. 2009. View Article : Google Scholar : PubMed/NCBI
28	Singer P, Shapiro H, Theilla M, Anbar R, Singer J and Cohen J: Anti-inflammatory properties of omega-3 fatty acids in critical illness: Novel mechanisms and an integrative perspective. Intensive Care Med. 34:1580–1592. 2008. View Article : Google Scholar : PubMed/NCBI
29	Calder PC: The relationship between the fatty acid composition of immune cells and their function. Prostaglandins Leukot Essent Fatty Acids. 79:101–368. 2008. View Article : Google Scholar : PubMed/NCBI
30	Chen B, Ni D and Zhang G: The role of early monitoring of CRP on evaluating severe sepsis. Shandong Yi Yao. 1–95. 2010.
31	Barton RG, Wells CL, Carlson A, Singh R, Sullivan JJ and Cerra FB: Dietary omega-3 fatty acids decrease mortality and kupffer cell prostaglandin E2 production in a rat model of chronic sepsis. J Trauma. 31:768–774. 1991. View Article : Google Scholar : PubMed/NCBI
32	Castelli GP, Pognani C, Cita M and Paladini R: Procalcitonin as a prognostic and diagnostic tool for septic complications after major trauma. Crit Care Med. 37:1845–1849. 2009. View Article : Google Scholar : PubMed/NCBI
33	Jongwutiwes U, Suitharak K, Tiengrim S and Thamlikitkul V: Serum procalcitonin in diagnosis of bacteremia. J Med Assoc Thai. 92 Suppl 2:S79–S87. 2009.PubMed/NCBI
34	Ko YC, Wu WP, Hsu CS, Dai MP, Ou CC and Kao CH: Serum and pleural fluid procalcitonin in predicting bacterial infection in patients with parapneumonic effusion. J Korean Med Sci. 24:398–402. 2009. View Article : Google Scholar : PubMed/NCBI
35	Mofidi R, Suttie SA, Patil PV, Ogston S and Parks RW: The value of procalcitonin at predicting the severity of acute pancreatitis and development of infected pancreatic necrosis: Systematic review. Surgery. 146:72–81. 2009. View Article : Google Scholar : PubMed/NCBI
36	Viñas Trullen X, Rodríguez López R, Pi S Porta, Terceros D Salazar, Sanz E Macarulla, Canal P Besora, Tellez F Alvarez, Castro C Iglesias and Palá X Feliu: Prospective study of procalcitonin as a diagnostic marker of the severity of secondary peritonitis. Cir Esp. 86:24–28. 2009.(In Spanish). View Article : Google Scholar : PubMed/NCBI
37	Rice TW, Wheeler AP, Thompson BT, de Boisblanc BP, Steingrub J and Rock P; NIH NHLBI Acute Respiratory Distress Syndrome Network of Investigators, : Enteral omega-3 fatty acid, gamma-linolenic acid, and antioxidant supplementation in acute lung injury. JAMA. 306:1574–1581. 2011. View Article : Google Scholar : PubMed/NCBI