The efficacy and acceptability of anti-inflammatory omega-3 polyunsaturated fatty acid supplements in sepsis management: a network meta-analysis of randomized controlled trials

Ping-Tao Tseng; Bing-Yan Zeng; Bing-Syuan Zeng; Pin-Yang Yeh; Brendon Stubbs; John S Kuo; Cheuk-Kwan Sun; Yu-Shian Cheng; Yen-Wen Chen; Tien-Yu Chen; Yi-Cheng Wu; Yu-Kang Tu; Pao-Yen Lin; Dian-Jeng Li; Chih-Sung Liang; Mein-Woei Suen; Yi-Che Lee; Wei-Chieh Yang; Chih-Wei Hsu; Yow-Ling Shiue; Kuan-Pin Su

doi:10.1016/j.plefa.2024.102633

The efficacy and acceptability of anti-inflammatory omega-3 polyunsaturated fatty acid supplements in sepsis management: a network meta-analysis of randomized controlled trials

Prostaglandins Leukot Essent Fatty Acids. 2024 Mar:202:102633. doi: 10.1016/j.plefa.2024.102633. Epub 2024 Jul 20.

Authors

Ping-Tao Tseng¹, Bing-Yan Zeng², Bing-Syuan Zeng³, Pin-Yang Yeh⁴, Brendon Stubbs⁵, John S Kuo⁶, Cheuk-Kwan Sun⁷, Yu-Shian Cheng⁸, Yen-Wen Chen⁹, Tien-Yu Chen¹⁰, Yi-Cheng Wu¹¹, Yu-Kang Tu¹², Pao-Yen Lin¹³, Dian-Jeng Li¹⁴, Chih-Sung Liang¹⁵, Mein-Woei Suen¹⁶, Yi-Che Lee¹⁷, Wei-Chieh Yang¹⁸, Chih-Wei Hsu¹⁹, Yow-Ling Shiue²⁰, Kuan-Pin Su²¹

Affiliations

¹ Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan; Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan; Institute of Precision Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan.
² Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Internal Medicine, E-Da Dachang Hospital, I-Shou University, Kaohsiung, Taiwan.
³ Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Internal Medicine, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan.
⁴ Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan; Clinical Psychology Center, Asia University Hospital, Taichung, Taiwan.
⁵ Institute of Psychiatry, King's College London, London, UK; Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK; Faculty of Health, Social Care Medicine and Education, Anglia Ruskin University, Chelmsford, UK.
⁶ Neuroscience and Brain Disease Center, China Medical University, Taichung, Taiwan; Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.
⁷ Department of Emergency Medicine, E-Da Dachang Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan.
⁸ Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Taiwan.
⁹ Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan.
¹⁰ Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei 112, Taiwan.
¹¹ Department of Sports Medicine, Landseed International Hospital, Taoyuan, Taiwan.
¹² Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.
¹³ Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
¹⁴ Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan.
¹⁵ Department of Psychiatry, Beitou Branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.
¹⁶ Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan; Gender Equality Education and Research Center, Asia University, Taichung, Taiwan; Department of Medical Research, Asia University Hospital, Asia University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan.
¹⁷ School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; Division of Nephrology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
¹⁸ Department of Pediatrics, Ping An Medical Clinic, Tainan, Taiwan.
¹⁹ Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
²⁰ Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Institute of Precision Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan.
²¹ Institute of Psychiatry, King's College London, London, UK; Mind-Body Interface Research Center (MBI-Lab), China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan; An-Nan Hospital, China Medical University, Tainan, Taiwan. Electronic address: [email protected].

PMID: 39159529
DOI: 10.1016/j.plefa.2024.102633

Abstract

Sepsis is a critical medical condition associated with high mortality for patients. Current pharmacological strategies for sepsis management or prevention had not achieved satisfactory results. The omega-3 fatty acids, with anti-inflammatory benefits, are considered to be promising agents for sepsis management/prevention. The aim of this network meta-analysis (NMA) is to compare the efficacy of various dosages and formulations of fish oil supplements for sepsis management and sepsis prevention. The current NMA consisted of two parts: (1) sepsis management and (2) sepsis prevention. The PubMed, ClinicalKey, Embase, ProQuest, Cochrane CENTRAL, ScienceDirect, Web of Science, and ClinicalTrials.gov databases were systematically searched to date of February 22^nd, 2024 for relevant randomized controlled trials (RCTs). RCTs were eligible for inclusion if they enrolled participants with a diagnosis of sepsis or who with high risk for sepsis. All NMA procedures were conducted under the frequentist model. The primary outcomes assessed are (1) mortality rate in sepsis treatment or (2) incidence of sepsis in sepsis prevention. Our NMA, based on 28 RCTs and 1718 participants (mean age=51.6 years, mean female proportion=35.6 %), showed that (1) high dose parenteral fish oil supplement yield the lowest mortality rate in sepsis management in adult patients, and (2) high dose enteral fish oil supplement yield the lowest incidence of sepsis in pediatric patients. This study provides compelling evidence that high-dose fish oil supplements provide beneficial effects for both sepsis management and sepsis prevention. Our findings provide a preliminary rationale for future large-scale RCTs to investigate the role of fish oil supplementation in sepsis management or prevention.

Keywords: Anti-inflammatory; Fish oil; Network meta-analysis; Omega-3 fatty acid; Polyunsaturated fatty acid; Randomized controlled trial; Sepsis.

Publication types

Meta-Analysis

MeSH terms

Adult
Aged
Anti-Inflammatory Agents / administration & dosage
Dietary Supplements*
Fatty Acids, Omega-3* / administration & dosage
Female
Fish Oils / administration & dosage
Humans
Male
Middle Aged
Network Meta-Analysis
Randomized Controlled Trials as Topic
Sepsis* / diet therapy
Sepsis* / drug therapy
Sepsis* / mortality
Sepsis* / prevention & control

Substances

Anti-Inflammatory Agents
Fatty Acids, Omega-3
Fish Oils