Arginine and glutamine supplementation on transthyretin levels in severely burned patients: A systematic review

Linden, Marcela Almeida; Teixeira, Thaís Longo de Morais; Freitas, Renata Germano Borges de Oliveira Nascimento; Bellomo-Brandão, Maria Ângela; Nogueira, Roberto José Negrão

doi:10.1016/j.nut.2022.111657

Cited by 3 publications

(4 citation statements)

References 28 publications

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“…In contrast, we aggregated data from eight single-center and two multicenter trials, of which one was from a single country ( n = 55) and one was an international, multicenter trial ( n = 1,201) conducted in 54 Burn Units from 14 countries (17, 25–33). Our findings are aligned with those reported in trials of glutamine supplementation in a heterogenous group of critically ill patients, which found glutamine supplementation was not efficacious (13, 36–41). Our SRMA found the route of glutamine delivery was not associated with improved outcomes or harm in burn injured patients.…”

Section: Discussionsupporting

confidence: 90%

The Efficacy of Glutamine Supplementation in Severe Adult Burn Patients: A Systematic Review With Trial Sequential Meta-Analysis

Ortiz-Reyes

Lee

Lew

et al. 2023

Critical Care Medicine

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OBJECTIVES: Evidence supporting glutamine supplementation in severe adult burn patients has created a state of uncertainty due to the variability in the treatment effect reported across small and large randomized controlled trials (RCTs). We aimed to systematically review the effect of glutamine supplementation on mortality in severe adult burn patients. DATA SOURCES: MEDLINE, Embase, CINAHL, and Cochrane Central were searched from inception to February 10, 2023. STUDY SELECTION: RCTs evaluating the effect of enteral or IV glutamine supplementation alone in severe adult burn patients were included. DATA EXTRACTION: Two reviewers independently extracted data on study characteristics, burn injury characteristics, description of the intervention between groups, adverse events, and clinical outcomes. DATA SYNTHESIS: Random effects meta-analyses were performed to estimate the pooled risk ratio (RR). Trial sequential analyses (TSA) for mortality and infectious complications were performed. Ten RCTs (1,577 patients) were included. We observed no significant effect of glutamine supplementation on overall mortality (RR, 0.65, 95% CI, 0.33–1.28; p = 0.21), infectious complications (RR, 0.83; 95% CI, 0.63–1.09; p = 0.18), or other secondary outcomes. In subgroup analyses, we observed no significant effects based on administration route or burn severity. We did observe a significant subgroup effect between single and multicenter RCTs in which glutamine significantly reduced mortality and infectious complications in singe-center RCTs but not in multicenter RCTs. However, TSA showed that the pooled results of single-center RCTs were type 1 errors and further trials would be futile. CONCLUSIONS: Glutamine supplementation, regardless of administration, does not appear to improve clinical outcomes in severely adult burned patients.

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Section: Discussionsupporting

confidence: 90%

The Efficacy of Glutamine Supplementation in Severe Adult Burn Patients: A Systematic Review With Trial Sequential Meta-Analysis

Ortiz-Reyes

Lee

Lew

et al. 2023

Critical Care Medicine

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“…It turned out that, in addition to decreased L-Arg, there was an early increase in the NOS level followed by its decline to the baseline, whereas arginase activity was elevated throughout the follow-up period [ 239 ]. These data are consistent with previous studies in a cohort of ICU trauma patients [ 240 ]. These patients had elevated peripheral blood mononuclear cell ARG1 activity throughout their ICU stay.…”

Section: Injuries and Surgical Interventionssupporting

confidence: 94%

“…Furthermore, patients with injuries were shown to have a reduced peripheral blood L-Arg level. Likewise, the level of L-Arg in the peripheral blood also tended to decrease in burns [ 240 ]. L-arg-containing supplements are often used in ICUs for various injuries [ 138 ].…”

Section: Injuries and Surgical Interventionsmentioning

confidence: 99%

“…L-arg-containing supplements are often used in ICUs for various injuries [ 138 ]. For instance, L-Arg used on burn patients increased their lymphoproliferative response, accelerated wound healing, markedly lowered C-reactive protein level, and contributed to a shorter ICU stay [ 240 ]. An L-Arg supplement is also used in preoperative patients’ diets, resulting in a lowered risk of infectious complications and a shortened hospital stay [ 241 ].…”

Section: Injuries and Surgical Interventionsmentioning

confidence: 99%

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Regulated Arginine Metabolism in Immunopathogenesis of a Wide Range of Diseases: Is There a Way to Pass between Scylla and Charybdis?

Старикова

Rubinstein

Mammedova

et al. 2023

CIMB

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More than a century has passed since arginine was discovered, but the metabolism of the amino acid never ceases to amaze researchers. Being a conditionally essential amino acid, arginine performs many important homeostatic functions in the body; it is involved in the regulation of the cardiovascular system and regeneration processes. In recent years, more and more facts have been accumulating that demonstrate a close relationship between arginine metabolic pathways and immune responses. This opens new opportunities for the development of original ways to treat diseases associated with suppressed or increased activity of the immune system. In this review, we analyze the literature describing the role of arginine metabolism in the immunopathogenesis of a wide range of diseases, and discuss arginine-dependent processes as a possible target for therapeutic approaches.

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The effect of perioperative specialized enteral nutrition on postoperative period after redo surgeries in patients with periprosthetic hip joint infection

Kazanin¹,

Zagrekov²,

Lebedev³

et al. 2023

Anaes. i reanim.

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Arginine and glutamine supplementation on transthyretin levels in severely burned patients: A systematic review

Cited by 3 publications

References 28 publications

The Efficacy of Glutamine Supplementation in Severe Adult Burn Patients: A Systematic Review With Trial Sequential Meta-Analysis

The Efficacy of Glutamine Supplementation in Severe Adult Burn Patients: A Systematic Review With Trial Sequential Meta-Analysis

Regulated Arginine Metabolism in Immunopathogenesis of a Wide Range of Diseases: Is There a Way to Pass between Scylla and Charybdis?

The effect of perioperative specialized enteral nutrition on postoperative period after redo surgeries in patients with periprosthetic hip joint infection

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