Intravenous omega-3 fatty acids are associated with better clinical outcome and less inflammation in patients with predicted severe acute pancreatitis: A randomised double blind controlled trial. Issue 9 (September 2020)

• Record Type: Journal Article
• Authors: Al-Leswas, D.; Eltweri, A.M.; Chung, W.-Y.; Arshad, A.; Stephenson, J.A.; Al-Taan, O.; Pollard, C.; Fisk, H.L.; Calder, P.C.; Garcea, G.; Metcalfe, M.S.; Dennison, A.R.
• Is Part Of: Clinical nutrition. Volume 39:Issue 9(2020)
• Page Start: 2711
• Page End: 2719
• Publication Date: 2020-09
• Subjects: C-reactive protein -- Organ failure -- Systemic inflammatory response syndrome -- Omega-3 -- Fish oil -- Severe acute pancreatitis; CRP C-reactive protein -- DHA docosahexenoic acid -- EPA eicosapentenoic acid -- EWS early warning score -- SIRS systemic inflammatory response syndrome -- FA fatty acid -- ICAM-1 intercellular adhesion molecule-1 -- IL interleukin -- MCT medium chain triglyceride -- MODS multiple organ dysfunction score -- PC phosphatidylcholine -- SOFA sequential organ failure assessment; Critically ill -- Nutrition -- Periodicals; Diet therapy -- Periodicals; Parenteral feeding -- Periodicals; Enteral feeding -- Periodicals; Enteral Nutrition -- Periodicals; Parenteral Nutrition -- Periodicals; Metabolism -- Periodicals; Diétothérapie -- Périodiques; Alimentation parentérale -- Périodiques; Alimentation entérale -- Périodiques; Nutrition -- Périodiques; Diet therapy; Enteral feeding; Nutrition; Parenteral feeding; Electronic journals; Periodicals; Electronic journals; 615.854
• DOI: 10.1016/j.clnu.2018.04.003
• Languages: English
• ISSNs: 0261-5614

Abstract

Summary: Background and aims: Omega-3 fatty acids (FA) can ameliorate the hyper-inflammatory response that occurs in conditions such as severe acute pancreatitis (SAP) and this may improve clinical outcome. We tested the hypothesis that parenteral omega-3 FA from a lipid emulsion that includes fish oil could be beneficial in patients with predicted SAP by reducing C-reactive protein (CRP) concentration (primary outcome), and modulating the inflammatory response and improving clinical outcome (secondary outcomes). Methods: In a phase II randomized double-blind single-centre controlled trial, patients with predicted SAP were randomised to receive a daily infusion of fish oil containing lipid emulsion (Lipidem® 20%, BBraun) for 7 days (n = 23) or a daily infusion of a lipid emulsion without fish oil (Lipofundin® MCT 20%, BBraun) (n = 22). Results: On admission, both groups had comparable pancreatitis predicted severity and APACHE II scores. Administration of fish oil resulted in lower total blood leukocyte number (P = 0.04), CRP (P = 0.013), interleukin-8 (P = 0.05) and intercellular adhesion molecule 1 (P = 0.01) concentrations, multiple organ dysfunction score, sequential organ failure assessment score (P = 0.004), early warning score (P = 0.01), and systemic inflammatory response syndrome (P = 0.03) compared to the control group. The fish oil group had fewer new organ failures (P = 0.07), lower critical care admission rate (P = 0.06), shorter critical care stay (P = 0.03) and shorter total hospital stay (P = 0.04). Conclusions: It is concluded that intravenous administration of a fish oil containing lipid emulsion, a source of omega-3 FA, improves clinical outcomes in patients with predicted SAP, benefits that may be linked to reduced inflammation. ClinicalTrials.gov number: NCT01745861 . EU Clinical Trials Register: EudraCT (2010-018660-16).