The effect of immunonutrition in patients with acute pancreatitis: a systematic review and meta-analysis.

Abstract

The effect of immunonutrition is controversial compared to standard supplementation with respect to the management of patients with acute pancreatitis. An online literature search on four databases (PubMed, Cochrane, Embase and Web of Science) was performed to identify all of the randomised controlled trials assessing the effects of enteral or parenteral immunonutrition in acute pancreatitis. A fixed or random effects model was chosen using revman, version 5.3 (https://revman.cochrane.org). The count data were analysed using the risk ratio (RR) and 95% confidence interval (CI). Five hundred and sixty-eight patients were included via our search in which 14 articles matched our criteria for enrolling the meta-analysis. Immunonutrition significantly reduced the risk of organ failure (RR=0.42; 95% CI=0.26-0.70, P=0.0008), infectious complications (RR=0.78; 95% CI=0.62-0.99; P=0.04) and mortality (RR=0.37; 95% CI=0.21-0.66; P=0.006). Length of hospital stay was also shorter in patients who received immunonutrition (mean difference=-1.73days; 95% CI=-2.36 to -1.10; P<0.00001). Total interventions of patients were decreased (RR=0.73; 95% CI=0.55-0.97; P=0.03). Body mass index in patients with immunonutrition was reduced more than standard nutrition (mean difference=-2.00; 95% CI=-3.96 to -0.04; P=0.05). Immunonutrition support such as glutamine and ω-3 fatty acids is potentially beneficial with respect to improving clinical outcomes in patients with acute pancreatitis.