Effects of fish oil lipid emulsion on risk of infection in patients with Crohn′s disease after enterectomy: a prospective study

Abstract

Objective To explore the effects of fish oil lipid emulsion on risk of infection in patients with Crohn′s disease (CD) after enterectomy. Methods The prospective study was conducted. The clinical data of 70 patients with CD who planned to receive enterectomy in the Nanfang Hospital of South Medical University between June 2015 and May 2017 were collected. All the patients were allocated into the fish oil group and control group by random number table method, and then underwent enterectomy by the same doctors′ team. Patients in the fish oil group received daily intravenous infusion of 100ml 10% fish oil lipid emulsion from day 1 to 5 postoperatively or longer) based on conventional treatment [combined other parenteral nutrition (PN) were selected according to patients′ conditions]; patients in the control group received conventional treatment (intravenous infusion of PN were selected according to patients′ conditions). Observation indicators: (1) postoperative infection situations between groups; (2) risk of postoperative infection and nutrition-related indexes between groups; (3) comparison of duration of postoperative hospital stay between groups. Measurement data with normal distribution were represented as ±s. The comparisons between groups were evaluated with the independent-sample t test and repeated measures data were analyzed by the repeated measures ANOVA. The comparisons of count data were analyzed using the chi-square test or Fisher exact probability. Odds ratio and 95% confidence interval (CI) for incidence of complications were calculated. Results Sixty-five patients were screened for eligibility, including 33 in the fish oil group and 32 in the control group. (1) Postoperative infection situations between groups: 18 patients in the 2 groups were complicated with postoperative infection. Abdominal infection, wound infection, anastomotic fistula, pulmonary infection and wound infection combined with intestinal fistula were detected in 7, 4, 4, 2 and 1 patients, respectively. Incidence of postoperative infection in the fish oil group and control group were respectively 15.2%(5/33) and 40.6%(13/32), with a statistically significant difference between groups (χ2=5.265, OR=0.261, 95%CI: 0.080-0.853, P 0.05). The levels of procalcitonin, C-reactive protein and albumin (Alb) from day 1 to 5 post-operatively were respectively from (1.92±1.41)ng/mL, (30±10)mg/L, (30.0±4.1)g/L to (1.00±0.96)ng/mL, (30±27)mg/L, (34.1±4.3)g/L in the fish oil group and from (2.15±1.16)ng/mL, (26±7)mg/L, (31.1±3.9)g/L to (2.02±1.86)ng/mL, (58±56)mg/L, (28.5±2.6)g/L in the control group, showing statistically significant differences in changing trend of above indexes between groups (F=5.053, 6.056, 6.709, P>0.05). (3) Comparison of duration of postoperative hospital stay between groups: duration of postoperative hospital stay in the fish oil group and control group were respectively (9±4)days and (12±6)days, with an average shortened time of 3 days, showing a statistically significant difference between groups (t=-2.443, P<0.05). Conclusion Intravenous infusion of fish oil lipid emulsion could reduce risk of postoperative infection in patients with CD after enterectomy, and also improve postoperatively patients′ nutritional status and shorten duration of hospital stay. Key words: Crohn′s disease; Complications; Infection; Nutrition support therapy; Fish oil; Omega-3 polyunsaturated fatty acids