The impact of glutamine dipeptides on outcome of surgical patients: systematic review of randomized controlled trials from Europe and Asia

Abstract

Summary Introduction : We systematically reviewed the clinical efficacy of glutamine dipeptide supplementation in surgical patients from prospective randomized controlled clinical trials (RCTs) from Europe and Asia. Material and methods : Medline, SCI, Embase, Cochrane Library and the Chinese Biomedicine Database were searched for European and Asian studies published in 1996 or later, that were RCTs for elective surgical patients. Parenteral nutrition, with or without l-alanyl-l-glutamine dipeptides (ala–gln), or in one study with or without glycyl-l-glutamine (gly–gln) dipeptides, was the only difference between intervention and control groups. Methodological quality assessment was based on Cochrane Reviewers' Handbook and Jada's Score Scale. Statistical software RevMan4.2 was used for meta-analysis. The data were treated by intention-to-treat method. Results : A total of 1335 titles were screened. Thirteen studies met our inclusion–exclusion criteria. Impact on infectious complication: 10 studies (pooled n = 355 ) were analyzed. Ala–gln significantly reduced infectious complications. Pooled relative risk (RR) was 0.42 (95% CI 0.24–0.72; P = 0.002 ). Impact on the length of hospital stay (LOS): Five studies (pooled n = 179 ) met our criteria. Glutamine dipeptides significantly reduced LOS by a weighted mean difference of 3.86 days (95% CI −6.03 to −1.68d; P 0.00001 ). Conclusion : Parenteral glutamine dipeptides showed significant reduction in infectious morbidity and LOS in a meta-analysis of European and Asian RCTs in elective surgery patients.