Enteral Glutamine Supplementation is Associated with Lowering Wound Infection Morbidity and Length of Hospital Stay among Burn Patients: A Meta-analysis and Systematic Review

Abstract

Background. Significant nutritional support to meet increased energy expenditure is vital for burn patient's survival. Burn injury may lead to a significant decrease in Glutamine levels, which inspired the hypothesis that glutamine supplementation following burn injury would improve outcomes. Hence, the purpose of this meta-analysis study was to provide the rationale for determining the efficacy and safety of enteral glutamine in burn patients.
 
 Methods. We conducted a meta-analysis based on PRISMA design to assess the potency of enteral glutamine supplementation as adjuvant treatment in patients with burn trauma. PubMed, Sciencedirect, and Google scholar were searched systematically using the following keywords: "enteral glutamine" and "burn patients" and "critical ill" and "infection" and "length of stay". Newcastle-Ottawa Scale (NOS) was used to assess the quality of papers included in our meta-analysis. A Z test was used to determine the significance of pooled effect estimates. Publication bias was assessed using Egger's. We used Comprehensive Meta-Analysis (CMA) version 2.1 to analyze the data.
 
 Results: A total of 12 studies recording 344 cases and 335 controls were enrolled for our analysis. Data on hospital Length of Stay (LOS) was found that enteral glutamine supplementation provided a significant result in reducing the LOS (Std mean diff: 0.70, 95%CI: 0.16 – 1.24; p=0.0100). We also found that a higher risk of positive wound culture was significantly observed in patients without the supplementation of enteral glutamine (OR 2.15, 95% CI: 1.41 – 3.27; p=0.0003) compared to patients receiving enteral glutamine supplementation among burn patients.
 
 Conclusion: In our meta-analysis study, enteral glutamine in burn patients confers significantly shorter LOS and lower risk of wound infection among burn patients. We suggest that enteral glutamine supplementation may be a beneficial intervention for the management of burn patients.

The Efficacy of Glutamine Supplementation in Severe Adult Burn Patients: A Systematic Review With Trial Sequential Meta-Analysis

“…In contrast, we aggregated data from eight single-center and two multicenter trials, of which one was from a single country ( n = 55) and one was an international, multicenter trial ( n = 1,201) conducted in 54 Burn Units from 14 countries (17, 25–33). Our findings are aligned with those reported in trials of glutamine supplementation in a heterogenous group of critically ill patients, which found glutamine supplementation was not efficacious (13, 36–41). Our SRMA found the route of glutamine delivery was not associated with improved outcomes or harm in burn injured patients.…”