Efficacy and safety of acupuncture as a complementary therapy for sepsis: a systematic review and meta-analysis

Abstract

Background: Sepsis is a life-threatening organ dysfunction caused by dysregulation of the host response to infection. Acupuncture is used for treatment of inflammatory diseases; however, its effectiveness and safety as a complementary therapy for sepsis has not been fully explored. Methods: Data were retrieved from eight databases. Randomized controlled trials (RCTs) that compared acupuncture plus conventional therapies versus conventional therapies alone were included. Pre-specified primary outcomes were mortality at 28 days and Acute Physiologic and Chronic Health Evaluation (APACHE) II scores. Results: A total of 17 studies with 1099 participants were included in this study. In terms of the primary outcomes, acupuncture plus routine therapy reduced mortality at 28 days (risk ratio (RR)): 0.69, 95% confidence interval (CI): 0.52 to 0.91, p < 0.001) and APACHE II scores (mean difference (MD): −2.84, 95% CI: −4.09 to −1.58, p < 0.001) at day 7 after treatment compared with routine therapy alone. In terms of secondary outcomes, acupuncture plus routine therapy reduced white blood cell counts and levels of procalcitonin (PCT), tumor necrosis factor (TNF)-α, interleukin (IL)-6 and lactic acid and intra-abdominal pressure (IAP), and improved CD3+, CD4+ and monocytes of human leukocyte antigen (HLA)-DR at day 7 after treatment compared with routine therapy alone. However, acupuncture plus routine therapy had no significant effects on levels of IL-10, C-reactive protein (CRP), CD8+ and CD4+/CD8+ ratios compared with routine therapy alone. Quality of evidence was low to very low for all parameters (GRADE). Conclusion: The available evidence showed that combination of acupuncture and routine therapy may have benefit for sepsis compared with use of routine therapy only. Due to the low degree of certainty regarding its effects, further research is required. Trial registration number: ICRD42019141491 (PROSPERO).

Revealing the biological mechanism of acupuncture in alleviating excessive inflammatory responses and organ damage in sepsis: a systematic review

“…Clinical evidence has accumulated regarding the extensive application of acupuncture in sepsis ( Table 1 ). In clinical practice, acupuncture intervention is usually combined with conventional clinical therapies such as anti-infection, nutritional support, fluid management, and mechanical ventilation, which can significantly reduce the systemic inflammatory response and organ damage as well as improve the function of immune cells in patients with sepsis ( 34 , 36 , 38 – 43 , 45 , 46 ). For example, 4 Hz continuous wave electroacupuncture (EA) at the Zusanli (ST36) and Shangjuxu (ST37) acupoints combined with conventional treatment can significantly reduce plasma procalcitonin (PCT), TNF-α, intestinal fatty acid binding protein (I-FABP), and D-lactic acid levels in patients with sepsis-induced intestinal dysfunction and intestinal obstruction syndrome, and plays a protective role in intestinal function ( 42 ).…”

“…Clinical studies have shown that acupuncture combined with conventional therapy can significantly reduce mortality and Acute Physiologic and Chronic Health Evaluation (APACHE) II scores in patients with sepsis. The white blood cell count, PCT, TNF-α, and IL-6 levels in blood were reduced, and CD3+, CD4+, and monocytes of HLA-DR were improved at day 7 after treatment compared with routine therapy alone ( 46 ), and the levels of T cell subsets and immunoglobulin (IgA and IgM) in the blood of sepsis patients were significantly increased ( 38 ). Human leukocyte antigen (HLA)-DR is a key effector molecule in the process of cell phagocytosis.…”

Sepsis y acupuntura: consideraciones sobre el manejo alterno en el paciente séptico

“…Los resultados mostraron que en los 17 estudios incluidos la acupuntura más el tratamiento habitual redujo la mortalidad a los 28 días (riesgo relativo [RR]): 0,69, intervalo de confianza (IC) del 95% 0,52 a 0,91, p < 0,001). Sin embargo, el grado bajo de (12). certeza de éste requiere estudios de ampliación de dichas alternativas combinadas Las condiciones en el paciente séptico suelen ser complejas en su abordaje por la gran variedad de sistemas involucrados en dicho proceso de enfermedad, el uso de terapia con acupuntura, si bien ha mostrado avances significativos en la inmunomodulación, no cubre del todo las demás implicaciones en el manejo de la sepsis como en los diferentes desenlaces asociados por complicaciones asociadas a la infección per se.…”

Aberrant parasympathetic responses in acupuncture therapy for restoring immune homeostasis

“…It is thought that the process of acupuncture harmonizes the body's energy and blood flow to induce profound psychophysical responses [1][2][3] . A series of basic and clinical studies have shown that acupuncture stimulation effectively manages and treats immunological diseases, including allergic disorders [4][5] , infections [6][7] , autoimmune diseases [8][9] , and immunodeficiency syndromes [10][11] . This non-pharmacological and noninvasive approach has attracted the attention of the clinical medicine community and has been advocated by leading researchers [12][13][14][15][16] .…”