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Intravenous omega-3 fatty acids are associated with better clinical outcome and less inflammation in patients with predicted severe acute pancreatitis: a randomised double blind controlled trial

Intravenous omega-3 fatty acids are associated with better clinical outcome and less inflammation in patients with predicted severe acute pancreatitis: a randomised double blind controlled trial
Intravenous omega-3 fatty acids are associated with better clinical outcome and less inflammation in patients with predicted severe acute pancreatitis: a randomised double blind controlled trial
Background and aims
Omega-3 fatty acids (FA) can ameliorate the hyper-inflammatory response that occurs in conditions such as severe acute pancreatitis (SAP) and this may improve clinical outcome. We tested the hypothesis that parenteral omega-3 FA from a lipid emulsion that includes fish oil could be beneficial in patients with predicted SAP by reducing C-reactive protein (CRP) concentration (primary outcome), and modulating the inflammatory response and improving clinical outcome (secondary outcomes).
Methods
In a phase II randomized double-blind single-centre controlled trial, patients with predicted SAP were randomised to receive a daily infusion of fish oil containing lipid emulsion (Lipidem® 20%, BBraun) for 7 days (n = 23) or a daily infusion of a lipid emulsion without fish oil (Lipofundin® MCT 20%, BBraun) (n = 22).
Results

On admission, both groups had comparable pancreatitis predicted severity and APACHE II scores. Administration of fish oil resulted in lower total blood leukocyte number (P = 0.04), CRP (P = 0.013), interleukin-8 (P = 0.05) and intercellular adhesion molecule 1 (P = 0.01) concentrations, multiple organ dysfunction score, sequential organ failure assessment score (P = 0.004), early warning score (P = 0.01), and systemic inflammatory response syndrome (P = 0.03) compared to the control group. The fish oil group had fewer new organ failures (P = 0.07), lower critical care admission rate (P = 0.06), shorter critical care stay (P = 0.03) and shorter total hospital stay (P = 0.04).
Conclusions
It is concluded that intravenous administration of a fish oil containing lipid emulsion, a source of omega-3 FA, improves clinical outcomes in patients with predicted SAP, benefits that may be linked to reduced inflammation.
0261-5614
Al-Leswas, D.
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Eltweri, A. M.
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Chung, W-Y
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Arshad, A.
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Stephenson, J. A.
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Al-Taan, O.
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Pollard, C.
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Fisk, H. L.
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Calder, P.C.
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Garcea, G.
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Metcalfe, M. S.
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Dennison, A. R.
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Al-Leswas, D.
9a9b5f4d-1a75-4f74-a365-d1d27a3cc7a0
Eltweri, A. M.
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Chung, W-Y
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Arshad, A.
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Stephenson, J. A.
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Al-Taan, O.
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Pollard, C.
f5b1b909-9b99-498a-a944-f2e3b96b39f3
Fisk, H. L.
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Calder, P.C.
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Garcea, G.
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Metcalfe, M. S.
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Dennison, A. R.
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Al-Leswas, D., Eltweri, A. M., Chung, W-Y, Arshad, A., Stephenson, J. A., Al-Taan, O., Pollard, C., Fisk, H. L., Calder, P.C., Garcea, G., Metcalfe, M. S. and Dennison, A. R. (2018) Intravenous omega-3 fatty acids are associated with better clinical outcome and less inflammation in patients with predicted severe acute pancreatitis: a randomised double blind controlled trial. Clinical Nutrition. (doi:10.1016/j.clnu.2018.04.003).

Record type: Article

Abstract

Background and aims
Omega-3 fatty acids (FA) can ameliorate the hyper-inflammatory response that occurs in conditions such as severe acute pancreatitis (SAP) and this may improve clinical outcome. We tested the hypothesis that parenteral omega-3 FA from a lipid emulsion that includes fish oil could be beneficial in patients with predicted SAP by reducing C-reactive protein (CRP) concentration (primary outcome), and modulating the inflammatory response and improving clinical outcome (secondary outcomes).
Methods
In a phase II randomized double-blind single-centre controlled trial, patients with predicted SAP were randomised to receive a daily infusion of fish oil containing lipid emulsion (Lipidem® 20%, BBraun) for 7 days (n = 23) or a daily infusion of a lipid emulsion without fish oil (Lipofundin® MCT 20%, BBraun) (n = 22).
Results

On admission, both groups had comparable pancreatitis predicted severity and APACHE II scores. Administration of fish oil resulted in lower total blood leukocyte number (P = 0.04), CRP (P = 0.013), interleukin-8 (P = 0.05) and intercellular adhesion molecule 1 (P = 0.01) concentrations, multiple organ dysfunction score, sequential organ failure assessment score (P = 0.004), early warning score (P = 0.01), and systemic inflammatory response syndrome (P = 0.03) compared to the control group. The fish oil group had fewer new organ failures (P = 0.07), lower critical care admission rate (P = 0.06), shorter critical care stay (P = 0.03) and shorter total hospital stay (P = 0.04).
Conclusions
It is concluded that intravenous administration of a fish oil containing lipid emulsion, a source of omega-3 FA, improves clinical outcomes in patients with predicted SAP, benefits that may be linked to reduced inflammation.

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YCLNU-D-17-00739R1 - Accepted Manuscript
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Accepted/In Press date: 2 April 2018
e-pub ahead of print date: 27 April 2018

Identifiers

Local EPrints ID: 420117
URI: http://eprints.soton.ac.uk/id/eprint/420117
ISSN: 0261-5614
PURE UUID: 85d17a0c-89c9-4d9e-ad74-2b8d159f2a33

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Date deposited: 27 Apr 2018 16:30
Last modified: 24 Jul 2019 04:01

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