Are three different lipid combinations effective on the immune system in sepsis patients?

Year 2024, , 112 - 118, 30.06.2024

Çağatay Küçükbingöz , Ebru Dündar Yenilmez , Murat Türkeün Ilgınel , Demet Laflı Tunay , Murat Gündüz

https://doi.org/10.36516/jocass.1477264

Abstract

Objective: We aimed to to analyze the effect of the 3 different parenteral nutritions (MCT/LCT (long and midium chain fatty acids), LCT with omega-9 (ω-9) and MCT/LCT with ω-3 and ω-9 on the inflamatory cytokine levels in sepsis patients. This is the first study from the Southern part of Turkey.
Patients and Methods: We included 30 patients, diagnosed with sepsis and took total parenteral nutrition in this study. Patients were divided into 3 randomized groups in terms of what parenteral nutrition have been taken. (Group A, B and C) Blood samples were taken and TNF-α, IL-1, IL-6 and IL-8 levels were evaluated. Adverse effects were recorded. TNF-α, IL-1β, IL-6, and IL-8 levels of were analyzed by ELISA method and each sample were studied in dublicate.
Results: The median age of the patients included in the study was 52 and 24 (80%) of them were male. The SOFA score was 5 in study group. We examined IL-1, IL-6, IL-8 and TNF-α distribution on the day of the first, third and fifth days depending on time. The inflamatory cytokine levels were not found statistically significant (p > 0.05) when we compared the study groups via 3 different parenteral nutritions.
Conclusion: When we compare MCT/LCT, LCT/ω-9 and MCT/LCT, ω-3, ω-9 which are given as a component of total parenteral nutrition we concluded that there was no superiority to others in terms of proinflamatory cytokin levels in sepsis and they didn’t increase proinflamatory cytokins. There is a need for more randomized controlled studies investigating the effect of lipids on the course of the disease in sepsis patients who cannot receive enteral nutrition and require TPN support.

Keywords

sepsis, lipid, cytocine

References

• 1. Wheeler AP and Bernard GR. Treating patients with severe sepsis. N Engl J Med. 1999;340:207-214. https://pubmed.ncbi.nlm.nih.gov/35157371/
• 2. Heyland DK, Hopman W, Coo H, Tranmer J and McColl MA. Long-term health-related quality of life in survivors of sepsis. Short Form 36: a valid and reliable measure of health-related quality of life. Crit Care Med . 2000;28:3599-3605. https://pubmed.ncbi.nlm.nih.gov/11098960/
• 3. Russell JA. Management of sepsis. N Engl J Med . 2006;355:1699-1713. https://pubmed.ncbi.nlm.nih.gov/17050894/
• 4. Cinel İ. PATHOGENESIS OF SEPSIS. Turkiye Klinikleri J Surg Med Sci. 2006;2:8-20.
• 5. McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, McCarthy MS, Davanos E, Rice TW and Cresci GA. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). JPEN J Parenter Enter Nutr . 2016;40:159-211. https://pubmed.ncbi.nlm.nih.gov/26773077/
• 6. Jones CJ and Calder PC. Influence of different intravenous lipid emulsions on fatty acid status and laboratory and clinical outcomes in adult patients receiving home parenteral nutrition: a systematic review. Clin Nutr . 2018;37:285-291. https://pubmed.ncbi.nlm.nih.gov/28065480/
• 7. Calder PC, Adolph M, Deutz NE, Grau T, Innes JK, Klek S, Lev S, Mayer K, Michael-Titus AT and Pradelli L. Lipids in the intensive care unit: Recommendations from the ESPEN Expert Group. Clin Nutr. 2018;37:1-18. https://pubmed.ncbi.nlm.nih.gov/28935438/
• 8. Carpentier YA and Dupont IE. Advances in intr avenous lipid emulsions. World J Surg . 2000;24:1493-1497. https://pubmed.ncbi.nlm.nih.gov/11193713/
• 9. Calder PC. Rationale and use of n-3 fatty acids in artificial nutrition. Proc Nutr Soc. 2010;69:565-573. https://pubmed.ncbi.nlm.nih.gov/20441676/
• 10. Calder PC. Use of fish oil in parenteral nutrition: rationale and reality. Proc Nutr Soc . 2006;65:264-277. https://pubmed.ncbi.nlm.nih.gov/16923311/
• 11. Adolph M. Lipid emulsions in parenteral nutrition Ann Nutr Metab.. 1999;43:1-13. https://pubmed.ncbi.nlm.nih.gov/10364625/ 12. Pradelli L, Mayer K, Muscaritoli M and Heller AR. n-3 fatty acid-enriched parenteral nutrition regimens in elective surgical and ICU patients: a meta-analysis. Crit Care. 2012;16:1-10. https://pubmed.ncbi.nlm.nih.gov/23036226/ 13. Mooi NM and Ncama BP. Evidence on nutritional therapy practice guidelines and implementation in adult critically ill patients: A systematic scoping review. Curationis. 2019;42:1-13. https://pubmed.ncbi.nlm.nih.gov/31833375/