Parenteral Nutrition Containing Fish Oil for Hospitalized Non-Intensive Care Unit (ICU) Patients: A Systematic Review, Meta-Analysis, and Cost-Effectiveness Analysis
Abstract
Background and aims: We investigated parenteral nutrition (PN) containing fish oil (FO-PN) vs. standard PN without fish oil (NF-PN) in adult patients hospitalized in the non-intensive care unit (general ward). Methods: Searches in Medline, Embase, and Web of Science (any date to 10 October 2024) were screened, data were extracted, and the quality of the studies was assessed by two independent researchers. Meta-analyses were performed, with outcomes included in random effects models, and heterogeneity for clinical outcomes was explored via subgroup analyses and meta-regression. Pharmacoeconomic analyses used data from the current meta-analysis. Results: In this study, 29 randomized controlled trials (RCTs) were included, with intervention and control groups given FO-PN and NF-PN, respectively, as part of PN covering ≥70% energy provision. Compared to NF-PN, FO-PN was associated with a 37% lower relative risk (RR) of infection (19 RCTs; RR 0.63, 95% confidence interval [CI] 0.50–0.78; p < 0.0001), 2.03 days shorter length of hospital stay (18 RCTs; 95% CI 1.23–2.84; p < 0.00001), and a 51% reduction in the risk of sepsis (10 RCTs; RR 0.49, 95% CI 0.32–0.74; p = 0.0009). There was a non-significant 54% reduction in the 30-day mortality rate (11 RCTs; RR 0.46, 95% CI 0.20–1.08; p = 0.07) for FO-PN. FO-PN was associated with better clinical outcomes and financial savings (i.e., dominance) compared to NF-PN in all five countries studied. Conclusions: FO-PN is a cost-effective…
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