Use of probiotics in the treatment of severe acute pancreatitis: a systematic review and meta-analysis of randomized controlled trials.
Crit Care. 2014 Mar 31;18(2):R57
Authors: Gou S, Yang Z, Liu T, Wu H, Wang C
Abstract
INTRODUCTION: Necrotic tissue infection can worsen the prognosis of severe acute pancreatitis (SAP), and probiotics have been shown to be beneficial in reducing the infection rate in animal experiments and primary clinical trials. However, the results of multicenter randomized clinical trials have been contradictory. The aim of this study was to systematically review and quantitatively analyze all randomized controlled trials with regard to important outcomes in patients with predicted SAP who received probiotics.
METHODS: A systematic literature search of the PubMed, Embase, and Cochrane Library databases was conducted using specific search terms. Eligible studies were randomized controlled trials that compared the effects of probiotics administration with placebo treatment in patients with predicted SAP. Mean difference (MD), risk ratio (RR), and 95% confidence interval (95% CI) were calculated using the Mantel-Haenszel fixed- and random-effects models. A meta-analysis on probiotics use in critical illness was also performed to serve as a reference.
RESULTS: In this study, 6 trials conducted in 536 patients were analyzed. Significant heterogeneities were observed in the type, dose, treatment duration, and clinical effects of probiotics among these trials. Systematic analysis showed that probiotics did not significantly affect the pancreatic infection rate (RR = 1.19, 95% CI: 0.74 to 1.93, P = 0.47), total infection (RR = 1.09, 95% CI: 0.80 to 1.48, P = 0.57), operation rate (RR = 1.42, 95% CI: 0.43 to 3.47, P = 0.71), hospital stay (MD = 2.45, 95% CI: -2.71 to 7.60, P = 0.35), or mortality (RR = 0.72, 95% CI: 0.42 to 1.45, P = 0.25).
CONCLUSIONS: Probiotics showed neither beneficial nor adverse effects on the clinical outcomes of patients with predicted SAP. However, significant heterogeneity was noted between the trials reviewed with regard to the type, dose, and treatment duration of probiotics, which may have contributed to the heterogeneity of their clinical outcomes. The current data are not sufficient to draw a conclusion on the effects of probiotics for patients with predicted SAP, and carefully designed clinical trials are needed to validate the effects of particular probiotics given at specific dosages and for specific treatment duration.
PMID: 24684832 [PubMed - as supplied by publisher]