Antioxidant micronutrient supplementation in critically ill adults: A systematic review with meta-analysis and trial sequential analysis

Gudivada, Kiran Kumar; Kumar, Ashish; Shariff, Mariam; Subramaniam, Sriram; Varma, Manu Mk.; Sivakoti, Sumitra; Krishna, Bhuvana

doi:10.1016/j.clnu.2020.06.033

Cited by 24 publications

(28 citation statements)

References 58 publications

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“…Following this first report, many medical specialties examined the results of "their" randomised-controlled trials for fragility and found similar results: trial results are often fragile [2][3][4][5]. Consequently, the fragility index has been extended to evaluate metaanalyses [8,14,15], and already been expanded to network meta-analyses [16]. Fragility quotient of the included meta-analyses with a cumulative sum to better visualise the distribution.…”

Section: Discussionmentioning

confidence: 99%

“…Fragility quotient is displayed as percent to ease interpretation We describe the first systematic assessment of metaanalyses in paediatric surgery using the fragility index and quotient. Preceding reports only used this metric for the assessment of their singular meta-analysis and found a fragility index of one [15] and nine [14] for their respective meta-analysis. The fragility index is an absolute metric that does not reflect the sample size of the included studies, for which the fragility quotient has been proposed [10].…”

Section: Discussionmentioning

confidence: 99%

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Meta-analyses in paediatric surgery are often fragile: implications and consequences

2021

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Purpose Meta-analyses occupy the highest level of evidence and thereby guide clinical decision-making. Recently, randomised-controlled trials were evaluated for the robustness of their findings by calculating the fragility index. The fragility index is the number of events that needs to be added to one treatment arm until the statistical significance collapses. We, therefore, aimed to evaluate the robustness of paediatric surgical meta-analyses. Methods We searched MEDLINE for paediatric surgical meta-analyses in the last decade. All meta-analyses on a paediatric surgical condition were eligible for analysis if they based their conclusion on a statistically significant meta-analysis. Results We screened 303 records and conducted a full-text evaluation of 60 manuscripts. Of them, 39 were included in our analysis that conducted 79 individual meta-analyses with significant results. Median fragility index was 5 (Q25–Q75% 2–11). Median fragility in relation to included patients was 0.77% (Q25–Q75% 0.29–1.87%). Conclusion Paediatric surgical meta-analyses are often fragile. In almost 60% of results, the statistical significance depends on less than 1% of the included population. However, as the fragility index is just a transformation of the P value, it basically conveys the same information in a different format. It therefore should be avoided.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Meta-analyses in paediatric surgery are often fragile: implications and consequences

2021

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“…An RCT (SISPCT) administering high-dose selenium to 1089 patients with severe sepsis or septic shock, the 28-day mortality rate in the selenium group was not significantly affected ( p = 0.30) [ 77 ]. A recent meta-analysis focusing on eight RCTs with low risk of bias did not find effects of antioxidant micronutrient supplementation on the reduction of mortality [ 78 ]. Currently, an international multicenter RCT of selenium in cardiac surgery (SUSTAIN-CSX, NCT02002247) is undergoing statistical evaluation [ 79 ].…”

Section: Supplementation With Specific Nutrientsmentioning

confidence: 99%

Nutrition in the Intensive Care Unit—A Narrative Review

Hill

Elke²,

Weimann

2021

Nutrients

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Background: While consent exists, that nutritional status has prognostic impact in the critically ill, the optimal feeding strategy has been a matter of debate. Methods: Narrative review of the recent evidence and international guideline recommendations focusing on basic principles of nutrition in the ICU and the treatment of specific patient groups. Covered topics are: the importance and diagnosis of malnutrition in the ICU, the optimal timing and route of nutrition, energy and protein requirements, the supplementation of specific nutrients, as well as monitoring and complications of a Medical Nutrition Therapy (MNT). Furthermore, this review summarizes the available evidence to optimize the MNT of patients grouped by primarily affected organ system. Results: Due to the considerable heterogeneity of the critically ill, MNT should be carefully adapted to the individual patient with special focus on phase of critical illness, metabolic tolerance, leading symptoms, and comorbidities. Conclusion: MNT in the ICU is complex and requiring an interdisciplinary approach and frequent reevaluation. The impact of personalized and disease-specific MNT on patient-centered clinical outcomes remains to be elucidated.

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“…Furthermore, the timing of administration, the dosage used, the duration of application, the patient population, and the outcome measures used 31 have to be considered cautiously for the interpretation of received findings. A detailed overview about the methodology of available studies on the use of vitamin C in critically ill patients has been summarized in previously published articles 32‐36 …”

Section: Current Evidence On the Use Of Vitamin C Treatment In Divers...mentioning

confidence: 99%

“…A detailed overview about the methodology of available studies on the use of vitamin C in critically ill patients has been summarized in previously published articles. [32][33][34][35][36]…”

Section: Current Evidence On the Use Of Vitamin C Treatment In Divers...mentioning

confidence: 99%

History of scurvy and use of vitamin C in critical illness: A narrative review

et al. 2022

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In 1747, an important milestone in the history of clinical research was set, as the Scottish surgeon James Lind conducted the first randomized controlled trial. Lind was interested in scurvy, a severe vitamin C deficiency which caused the death of thousands of British seamen. He found that a dietary intervention with oranges and lemons, which are rich in vitamin C by nature, was effective to recover from scurvy. Because of its antioxidative properties and involvement in many biochemical processes, the essential micronutrient vitamin C plays a key role in the human biology. Moreover, the use of vitamin C in critical illness-a condition also resulting in death of thousands in the 21st century-has gained increasing interest, as it may restore vascular responsiveness to vasoactive agents, ameliorate microcirculatory blood flow, preserve endothelial barriers, augment bacterial defense, and prevent apoptosis. Because of its redox potential and powerful antioxidant capacity, vitamin C represents an inexpensive and safe antioxidant, with the potential to modify the inflammatory cascade and improve clinical outcomes of critically ill patients. This narrative review aims to update and provide an overview on the role of vitamin C in the human biology and in critically ill patients, and to summarize current evidence on the use of vitamin C in diverse populations of critically ill patients, in specific focusing on patients with sepsis and coronavirus disease 2019.

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Antioxidant micronutrient supplementation in critically ill adults: A systematic review with meta-analysis and trial sequential analysis

Cited by 24 publications

References 58 publications

Meta-analyses in paediatric surgery are often fragile: implications and consequences

Meta-analyses in paediatric surgery are often fragile: implications and consequences

Nutrition in the Intensive Care Unit—A Narrative Review

History of scurvy and use of vitamin C in critical illness: A narrative review

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