دورية أكاديمية
Glutamine and antioxidants in the critically ill patient: a post hoc analysis of a large-scale randomized trial.
| العنوان: | Glutamine and antioxidants in the critically ill patient: a post hoc analysis of a large-scale randomized trial. |
|---|---|
| المؤلفون: | Heyland, D.K., Elke, G., Cook, D., Berger, M.M., Wischmeyer, P.E., Albert, M., Muscedere, J., Jones, G., Day, A.G. |
| المساهمون: | Canadian Critical Care Trials Group, Muscedere, J., Hammond, C., Meyers, M., Fleury, S., O' Callaghan, N., Cook, D., McDonald, E., Clarke, F., Jones, G., Watpool, I., McArdle, T., Porteous, R., Pagliarello, G., Chittock, D., Gardner, M., Logie, S., Foster, D., Albert, M., Deroy, P., Simard, H., Ahern, S., Harvey, J., Magder, S., Banici, L., Kutsogiannis, J., Thompson, P., Scott, K., Bartel, R., Jossy, D., Krawchuk, C., Stollery, D., Barchard, J., Krause, M., Wood, G., Auld, F., Atkins, L., Martin, C., Campbell, E., Hall, R., Julien, L., Khwaja, K., Lauzier, F., Gagne, C., Thibodeault, M., Leonard, P., Mehta, S., Brown, M., Mele, T., Bentall, T., Lellouche, F., Ferland, MC., Meade, M., Hand, L., McDonald, B., Winch, D., Fowler, R., Marinoff, N., Dodek, P., Ashley, BJ., Wiebe, K., Janz, W., Wischmeyer, P., Luzier, E., Baer, A., McCarthy, M., Chowayou, L., Garrett, K., Allen, F., Stapleton, R., Martin, J., Shea, B., Saad, M., DeSpirito, C., Kosar, R., Podbielski, J., Vincent, L., Morin, K., Dudick, C., White, J., Frankel, H., Smith, LA., White, T., Kinikini, M., Briggs, B., Murray, M., Watkins, A., Berger, M., Delodder, F., Elke, G., Weiler, N., Schulz-Ruthenberg, N., D' Aria, S., Gründling, M., Kuhn, SO., Guderian, L., Bause, H., Gabriel, P., Prause, A., Wolf, C. |
| المصدر: | Jpen. Journal of Parenteral and Enteral Nutrition, vol. 39, no. 4, pp. 401-409 |
| سنة النشر: | 2015 |
| مصطلحات موضوعية: | Aged, Antioxidants/adverse effects, Antioxidants/therapeutic use, Critical Illness/mortality, Critical Illness/therapy, Dietary Supplements/adverse effects, Glutamine/adverse effects, Glutamine/therapeutic use, Hospital Mortality, Humans, Kidney, Logistic Models, Middle Aged, Multiple Organ Failure/mortality, Multiple Organ Failure/therapy, Odds Ratio, Prospective Studies, socio, envir |
| الوصف: | BACKGROUND: The recent large randomized controlled trial of glutamine and antioxidant supplementation suggested that high-dose glutamine is associated with increased mortality in critically ill patients with multiorgan failure. The objectives of the present analyses were to reevaluate the effect of supplementation after controlling for baseline covariates and to identify potentially important subgroup effects. MATERIALS AND METHODS: This study was a post hoc analysis of a prospective factorial 2 × 2 randomized trial conducted in 40 intensive care units in North America and Europe. In total, 1223 mechanically ventilated adult patients with multiorgan failure were randomized to receive glutamine, antioxidants, both glutamine and antioxidants, or placebo administered separate from artificial nutrition. We compared each of the 3 active treatment arms (glutamine alone, antioxidants alone, and glutamine + antioxidants) with placebo on 28-day mortality. Post hoc, treatment effects were examined within subgroups defined by baseline patient characteristics. Logistic regression was used to estimate treatment effects within subgroups after adjustment for baseline covariates and to identify treatment-by-subgroup interactions (effect modification). RESULTS: The 28-day mortality rates in the placebo, glutamine, antioxidant, and combination arms were 25%, 32%, 29%, and 33%, respectively. After adjusting for prespecified baseline covariates, the adjusted odds ratio of 28-day mortality vs placebo was 1.5 (95% confidence interval, 1.0-2.1, P = .05), 1.2 (0.8-1.8, P = .40), and 1.4 (0.9-2.0, P = .09) for glutamine, antioxidant, and glutamine plus antioxidant arms, respectively. In the post hoc subgroup analysis, both glutamine and antioxidants appeared most harmful in patients with baseline renal dysfunction. No subgroups suggested reduced mortality with supplements. CONCLUSIONS: After adjustment for baseline covariates, early provision of high-dose glutamine administered separately from artificial nutrition was not beneficial and ... |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| العلاقة: | https://serval.unil.ch/notice/serval:BIB_594EA1B9D9D1Test |
| الإتاحة: | https://serval.unil.ch/notice/serval:BIB_594EA1B9D9D1Test |
| حقوق: | undefined |
| رقم الانضمام: | edsbas.31A48647 |
| قاعدة البيانات: | BASE |
| الوصف غير متاح. |