Impact of Omega-3 Fatty Acid Supplementation in Parenteral Nutrition on Inflammatory Markers and Clinical Outcomes in Critically Ill COVID-19 Patients: A Randomized Controlled Trial
Abstract
:1. Introduction
2. Materials and Methods
- Group I received the standard LE according to hospital protocol. Since we use different kinds of multichamber-bag (MCB) PNs, they may receive different amounts of O3FA included in the regular LE.
- Group II received 0.1 g/kg/day of fish oil (Omegaven®) plus the amount of LE containing LC/MCT/omega-9 and O3FA (Smoflipid®) to reach the total amount of lipid prescribed.
- Group III received 0.2 g/kg/day of fish oil (Omegaven®) plus the amount of LE containing LC/MCT/omega-9 and O3FA (Smoflipid®) to reach the total amount of lipid prescribed.
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Zhu, N.; Zhang, D.; Wang, W.; Li, X.; Yang, B.; Song, J.; Zhao, X.; Huang, B.; Shi, W.; Lu, R.; et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N. Engl. J. Med. 2020, 382, 727–733. [Google Scholar] [CrossRef]
- Silva, M.J.A.; Ribeiro, L.R.; Gouveia, M.I.M.; Marcelino, B.d.R.; Santos, C.S.d.; Lima, K.V.B.; Lima, L.N.G.C. Hyperinflammatory Response in COVID-19: A Systematic Review. Viruses 2023, 15, 553. [Google Scholar] [CrossRef] [PubMed]
- Batah, S.S.; Fabro, A.T. Pulmonary Pathology of ARDS in COVID-19: A Pathological Review for Clinicians. Respir. Med. 2021, 176, 106239. [Google Scholar] [CrossRef]
- Lamers, M.M.; Haagmans, B.L. SARS-CoV-2 Pathogenesis. Nat. Rev. Microbiol. 2022, 20, 270–284. [Google Scholar] [CrossRef] [PubMed]
- Lazar, M.; Sandulescu, M.; Barbu, E.C.; Chitu-Tisu, C.E.; Andreescu, D.I.; Anton, A.N.; Erculescu, T.M.; Petre, A.M.; Duca, G.T.; Simion, V.; et al. The Role of Cytokines and Molecular Pathways in Lung Fibrosis Following SARS-CoV-2 Infection: A Physiopathologic (Re)View. Biomedicines 2024, 12, 639. [Google Scholar] [CrossRef] [PubMed]
- Buckley, C.D.; Gilroy, D.W.; Serhan, C.N. Proresolving Lipid Mediators and Mechanisms in the Resolution of Acute Inflammation. Immunity 2014, 40, 315–327. [Google Scholar] [CrossRef] [PubMed]
- Basil, M.C.; Levy, B.D. Specialized Pro-Resolving Mediators: Endogenous Regulators of Infection and Inflammation. Nat. Rev. Immunol. 2016, 16, 51–67. [Google Scholar] [CrossRef]
- Ishihara, T.; Yoshida, M.; Arita, M. Omega-3 Fatty Acid-Derived Mediators That Control Inflammation and Tissue Homeostasis. Int. Immunol. 2019, 31, 559–567. [Google Scholar] [CrossRef]
- Gutiérrez, S.; Svahn, S.L.; Johansson, M.E. Effects of Omega-3 Fatty Acids on Immune Cells. Int. J. Mol. Sci. 2019, 20, 5028. [Google Scholar] [CrossRef]
- Torrinhas, R.S.; Calder, P.C.; Lemos, G.O.; Waitzberg, D.L. Parenteral Fish Oil: An Adjuvant Pharmacotherapy for Coronavirus Disease 2019? Nutrition 2021, 81, 110900. [Google Scholar] [CrossRef]
- Calder, P.C. Marine Omega-3 Fatty Acids and Inflammatory Processes: Effects, Mechanisms and Clinical Relevance. Biochim. Biophys. Acta Mol. Cell Biol. Lipids 2015, 1851, 469–484. [Google Scholar] [CrossRef] [PubMed]
- Gusev, E.; Sarapultsev, A.; Solomatina, L.; Chereshnev, V. Sars-Cov-2-Specific Immune Response and the Pathogenesis of COVID-19. Int. J. Mol. Sci. 2022, 23, 1716. [Google Scholar] [CrossRef] [PubMed]
- Barazzoni, R.; Bischoff, S.C.; Breda, J.; Wickramasinghe, K.; Krznaric, Z.; Nitzan, D.; Pirlich, M.; Singer, P. ESPEN Expert Statements and Practical Guidance for Nutritional Management of Individuals with SARS-CoV-2 Infection. Clin. Nutr. 2020, 39, 1631–1638. [Google Scholar] [CrossRef] [PubMed]
- Singer, P.; Blaser, A.R.; Berger, M.M.; Alhazzani, W.; Calder, P.C.; Casaer, M.P.; Hiesmayr, M.; Mayer, K.; Montejo, J.C.; Pichard, C.; et al. ESPEN Guideline on Clinical Nutrition in the Intensive Care Unit. Clin. Nutr. 2019, 38, 48–79. [Google Scholar] [CrossRef]
- Calder, P.C.; Adolph, M.; Deutz, N.E.; Grau, T.; Innes, J.K.; Klek, S.; Lev, S.; Mayer, K.; Michael-Titus, A.T.; Pradelli, L.; et al. Lipids in the Intensive Care Unit: Recommendations from the ESPEN Expert Group. Clin. Nutr. 2018, 37, 1–18. [Google Scholar] [CrossRef]
- Pradelli, L.; Klek, S.; Mayer, K.; Omar Alsaleh, A.J.; Rosenthal, M.D.; Heller, A.R.; Muscaritoli, M. Omega-3 Fatty Acid-Containing Parenteral Nutrition in ICU Patients: Systematic Review with Meta-Analysis and Cost-Effectiveness Analysis. Crit. Care 2020, 24, 634. [Google Scholar] [CrossRef]
- Pradelli, L.; Mayer, K.; Klek, S.; Rosenthal, M.D.; Povero, M.; Heller, A.R.; Muscaritoli, M. Omega-3 Fatty Acids in Parenteral Nutrition—A Systematic Review with Network Meta-Analysis on Clinical Outcomes. Clin. Nutr. 2023, 42, 590–599. [Google Scholar] [CrossRef]
- Velotti, F.; Costantini, L.; Merendino, N. Omega-3 Polyunsaturated Fatty Acids (n-3 PUFAs) for Immunomodulation in COVID-19 Related Acute Respiratory Distress Syndrome (ARDS). J. Clin. Med. 2023, 12, 304. [Google Scholar] [CrossRef] [PubMed]
- Sungurtekin, H.; Deǧirmenci, S.; Sungurtekin, U.; Oguz, B.E.; Sabir, N.; Kaptanoglu, B. Comparison of the Effects of Different Intravenous Fat Emulsions in Patients with Systemic Inflammatory Response Syndrome and Sepsis. Nutr. Clin. Pract. 2011, 26, 665–671. [Google Scholar] [CrossRef]
- Pimentel, R.F.W.; Silva, A.P.; Santana, A.I.C.; Silva, D.d.S.e.; Ramos, M.d.S.; de Souza, M.C.; Suen, V.M.M.; Maduro, I.P.d.N.N.; Filho, D.R.; Júnior, A.D.; et al. Effect of Immunonutrition on Serum Levels of C-Reactive Protein and Lymphocytes in Patients with COVID-19: A Randomized, Controlled, Double-Blind Clinical Trial. Nutr. Hosp. 2022, 39, 20–26. [Google Scholar] [CrossRef]
- Sedighiyan, M.; Abdollahi, H.; Karimi, E.; Badeli, M.; Erfanian, R.; Raeesi, S.; Hashemi, R.; Vahabi, Z.; Asanjarani, B.; Mansouri, F.; et al. Omega-3 Polyunsaturated Fatty Acids Supplementation Improve Clinical Symptoms in Patients with Covid-19: A Randomised Clinical Trial. Int. J. Clin. Pract. 2021, 75, e14854. [Google Scholar] [CrossRef]
- Soliman, O.M.; Abbas, Y.H.; Aboelhassan, A.M.A.; Ismail, E.A. Could Early Infusion of Fish-Oil-Based Lipid Emulsion Affect the Need for Intensive Care in Moderately Diseased COVID-19 Patients? A Randomized Clinical Trial. Ain-Shams J. Anesthesiol. 2022, 14, 54. [Google Scholar] [CrossRef]
- Kosmopoulos, A.; Bhatt, D.L.; Meglis, G.; Verma, R.; Pan, Y.; Quan, A.; Teoh, H.; Verma, M.; Jiao, L.; Wang, R.; et al. A Randomized Trial of Icosapent Ethyl in Ambulatory Patients with COVID-19. iScience 2021, 24, 103040. [Google Scholar] [CrossRef] [PubMed]
- Taha, A.M.; Shaarawy, A.S.; Omar, M.M.; Abouelmagd, K.; Shalma, N.M.; Alhashemi, M.; Ahmed, H.M.; Allam, A.H.; Abd-ElGawad, M. Effect of Omega-3 Fatty Acids Supplementation on Serum Level of C-Reactive Protein in Patients with COVID-19: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J. Transl. Med. 2022, 20, 401. [Google Scholar] [CrossRef] [PubMed]
- Yue, H.-Y.; Zeng, J.; Wang, Y.; Deng, M.J.; Peng, W.; Tan, X.; Jiang, H. Efficacy of Omega-3 Fatty Acids for Hospitalized COVID-19 Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Asia Pac. J. Clin. Nutr. 2023, 32, 308–320. [Google Scholar] [PubMed]
- Wang, H.; Su, S.; Wang, C.; Hu, J.; Dan, W.; Peng, X. Effects of Fish Oil-Containing Nutrition Supplementation in Adult Sepsis Patients: A Systematic Review and Meta-Analysis. Burns Trauma. 2022, 10, tkac012. [Google Scholar] [CrossRef] [PubMed]
- Arnardottir, H.; Pawelzik, S.; Sarajlic, P.; Quaranta, A.; Kolmert, J.; Religa, D.; Wheelock, C.E.; Bäck, M. Immunomodulation by Intravenous Omega-3 Fatty Acid Treatment in Older Subjects Hospitalized for COVID-19: A Single-blind Randomized Controlled Trial. Clin. Transl. Med. 2022, 12, e895. [Google Scholar] [CrossRef]
- Doaei, S.; Gholami, S.; Rastgoo, S.; Gholamalizadeh, M.; Bourbour, F.; Bagheri, S.E.; Samipoor, F.; Akbari, M.E.; Shadnoush, M.; Ghorat, F.; et al. The Effect of Omega-3 Fatty Acid Supplementation on Clinical and Biochemical Parameters of Critically Ill Patients with COVID-19: A Randomized Clinical Trial. J. Transl. Med. 2021, 19, 128. [Google Scholar] [CrossRef]
- Li, T.; Wang, D.; Wei, H.; Xu, X. Cytokine Storm and Translating IL-6 Biology into Effective Treatments for COVID-19. Front. Med. 2023, 17, 1080–1095. [Google Scholar] [CrossRef]
- Berlana, D. Parenteral Nutrition Overview. Nutrients 2022, 14, 4480. [Google Scholar] [CrossRef]
- Mateu-de Antonio, J.; Florit-Sureda, M. New Strategy to Reduce Hypertriglyceridemia During Parenteral Nutrition While Maintaining Energy Intake. J. Parenter. Enter. Nutr. 2016, 40, 705–712. [Google Scholar] [CrossRef] [PubMed]
Parameter | Group I—No O3FA added (N = 24) | Group II—0.1 g/Kg/d O3FA (N = 24) | Group II—0.2 G/kg/d O3FA (N = 21) | Group II+III (N = 45) |
---|---|---|---|---|
Age, years | 63.2 (5.6) | 59.1 (10.5) | 57.6 (11.9) | 58.3 (11.0) |
BMI | 30.2 (4.2) | 31.0 (7.2) | 30.2 (4.9) | 30.6 (6.2) |
Weight, Kg | 88.7 (12.6) | 89.9 (26.9) | 83.8 (13.6) | 87.1 (21.8) |
Male, n (%) | 22 (91.6) | 19 (79.2) | 17 (81.0) | 36 (80.0) |
Hospital stay before PN, days | 11.9 (6.0) | 11.1 (8.3) | 10.3 (7.6) | 10.7 (7.9) |
ICU stay before PN, days | 10.0 (6.6) | 7.9 (6.4) | 8.2 (7.1) | 8.1 (6.7) |
APACHE II at ICU admission | 17.4 (5.2) | 19.0 (5.8) | 17.2 (4.9) | 18.2 (5.4) |
APACHE II at PN start | 17.8 (5.5) | 19.3 (6.1) | 18.9 (3.3) | 19.1 (4.9) |
CRP, mg/L | 12.36 (9.04) | 13.28 (9.28) 2 | 8.34 (8.59) 1 | 10.97 (9.28) |
IL-6, pg/mL | 619.95 (1473.11) | 929.41 (1841.55) 2 | 404.86 (1037.62) 1 | 684.62 (1527.14) |
Total bilirubin, mg/dL | 0.82 (0.38) | 1.03 (1.13) | 0.89 (1.12) | 0.96 (1.11) |
AP, U/dL | 124.91 (92.23) | 140.42 (116.97) | 100.90 (60.53) | 121.98 (96.0) |
GGT, U/dL | 211.09 (188.06) | 273.42 (262.07) | 176.05 (123.75) | 227.98 (212.78) |
Triglycerides, mg/dL | 255.04 (109.33) | 289.21 (152.30) | 216.43 (79.61) | 255.24 (127.89) |
Variable | Allocation Group | Day 1 to Day 5 | Day 1 to Day 10 |
---|---|---|---|
CRP, mg/L | Group I | 10.95 (7.78)–9.54 (8.51) [n = 17] | 10.15 (8.08)–13.97 (8.08) [n = 14] |
Group II | 13.65 (9.46)–8.67 (8.03) [n = 23] * | 13.23 (9.04)–10.28 (8.78) [n = 19] * | |
Group III | 9.04 (9.02)–8.91 (7.46) [n = 17] | 9.40 (10.61)–14.80 (13.27) [n = 12] | |
Group II+III | 11.50 (9.53)–8.77 (7.78) [n = 40] * | 11.65 (9.55)–11.98 (10.66) [n = 31] | |
IL-6, pg/mL | Group I | 358.54 (707.48)–165.55 (233.32) [n = 17] | 304.78 (673.72)–95.25 (103.72) [n = 14] |
Group II | 894.60 (1874.85)–506.31 (1127.1) [n = 23] * | 1095.61 (2085.00)–294.51 (645.20) [n = 19] * | |
Group III | 492.18 (1141.47)–376.18 (995.12) [n = 17] | 325.80 (725.26)–426.32 (835.14) [n = 12] | |
Group II+III | 723.57 (1599.37)–451.00 (1061.66) [n = 40] * | 768.22 (1676.38)–336.78 (706.69) [n = 31] * | |
IFN-γ, pg/mL | Group I | 0.97 (1.11)–1.56 (1.91) [n = 9] | 1.02 (1.11)–5.52 (7.65) [n = 8] |
Group II | 1.37 (1.16)–2.10 (3.04) [n = 13] | 2.19 (2.75)–1.63 (1.43) [n = 11] | |
Group III | 4.01 (4.00)–19.03 (41.48) [n = 9] | 3.89 (3.92)–6.40 (9.14) [n = 5] | |
Group II+III | 2.45 (2.94)–9.02 (27.08) [n = 22] | 2.72 (3.13)–3.12 (5.37) [n = 16] | |
TNF-α, pg/mL | Group I | 21.37 (10.77)–18.33 (7.98) [n = 9] | 18.82 (7.41)–23.03 (9.37) [n = 8] |
Group II | 23.38 (19.57)–20.49 (14.75) [n = 13] | 32.55 (33.42)–23.22 (16.92) [n = 11] | |
Group III | 22.97 (8.34)–22.88 (12.92) [n = 9] | 26.73 (5.35)–26.72 (22.70) [n = 5] | |
Group II+III | 23.21 (15.67)–21.47 (13.76) [n = 22] | 30.73 (27.57)–24.31 (18.19) [n = 16] | |
IL-1Ra, pg/mL | Group I | 1745.44 (816.75)–3398.63 (2242.79) [n = 9] * | 1706.25 (727.72)–4599.13 (2984.13) [n = 8] * |
Group II | 4849.01 (5990.47)–4040.12 (3411.48) [n = 13] | 5688.03 (6511.04)–5302.14 (5644.86) [n = 11] | |
Group III | 3024.61 (2031.39)–4343.72 (4416.36) [n = 9] | 3906.40 (2095.45)–4304.20 (5615.06) [n = 5] | |
Group II+III | 4102.66 (4787.59)–4164.32 (3755.52) [n = 22] | 5131.27 (5491.88)–4990.28 (5466.31) [n = 16] | |
CXCL10, pg/mL | Group I | 448.33 (272.87)–522.26 (410.64) [n = 9] | 418.50 (224.66)–515.68 (322.15) [n = 8] |
Group II | 757.05 (682.09)–380.50 (161.87) [n = 13] * | 963.27 (786.52)–435.05 (231.70) [n = 11] * | |
Group III | 1155.71 (826.90)–689.61 (563.26) [n = 9] | 1342.30 (735.94)–663.15 (421.25) [n = 5] | |
Group II+III | 920.14 (752.72)–506.95 (400.04) [n = 22] * | 1081.71 (767.96)–506.33 (308.28) [n = 16] * |
Parameter | Group I No O3FA added (N = 17) | Group II 0.1 g/Kg/d O3FA (N = 23) | Group II 0.2 G/kg/d O3FA (N = 17) | Group II+III (N = 40) |
---|---|---|---|---|
PN days | 17.76 (7.51) | 16.74 (11.97) | 13.29 (6.44) | 16.48 (10.94) |
APACHE II score ICU admission | 17.41 (5.17) | 19.30 (5.68) | 16.82 (4.65) | 18.25 (5.35) |
APACHE II score PN start | 17.11 (5.59) | 19.52 (6.13) | 19.00 (3.55) | 19.30 (5.14) |
kcal/day | 1553.85 (111.12) | 1673.98 (928.70) | 1476.85 (145.88) | 1590.20 (710.63) |
Lipid g/day | 47.59 (10.91) | 50.94 (30.76) | 48.82 (9.53) | 50.04 (23.92) |
O3FA g/day | 4.81 (1.75) | 14.33 (3.28) | 21.30 (4.09) | 17.29 (5.01) |
O3FA g/kg/day | 0.05 (0.02) 2,3 | 0.16 (0.03) 1,3 | 0.26 (0.06) 1,3 | 0.20 (0.06)1 |
Kcal/kg/day (day 5) | 15.62 (2.43) | 15.25 (3.93) | 16.75 (2.45) | 15.89 (3.43) |
Lipid g/kg/day (day 5) | 0.49 (0.16) | 0.46 (0.17) | 0.54 (0.13) | 0.50 (0.16) |
O3FA g/day (day 5) | 3.36 (1.70) | 13.65 (2.83) | 21.83 (5.50) | 17.13 (5.81) |
Kcal/kg/day (day 10) | 16.42 (9.92) | 15.28 (203.98) | 17.67 (2.75) | 16.24 (3.40) |
Lipid g/kg/day (day 10) | 0.50 (0.17) | 0.46 (0.16) | 0.57 (0.14) | 0.50 (0.16) |
O3FA g/day (day 10) | 4.70 (1.57) 2,3 | 15.25 (3.54) 1,3 | 21.95 (4.74) 1,3 | 17.93 (5.20) 1 |
Secondary Outcomes (Per-Protocol) | Group I (N = 24) | Group II (N = 24) | Group III (N = 19) | Group II+III (N = 43) |
Hospital LOS, days | 74.83 (55.46) 3,2+3 | 56.60 (34.18) * | 31.42 (11.86) 1 | 45.41 (29.18) 1 |
ICU LOS, days | 38.89 (24.99) 3,2+3 | 32.67 (20.90) * | 15.92 (5.82) 1 | 25.22 (17.93) 1 |
Mortality, n (%) | 3 (25.00) | 9 (37.50) | 7 (36.84) | 16 (37.21) |
Secondary Outcomes (Intention-to-Treat) | Group I (N = 24) | Group II (N = 24) | Group III (N = 21) | Group II+III (N = 45) |
Hospital LOS, days | 74.83 (55.46) 3,2+3 | 56.60 (34.18) | 38.38 (27.57) 1 | 48.14 (32.01) 1 |
ICU LOS, days | 38.89 (24.99) 3,2+3 | 32.67 (20.90) | 19.85 (15.23) 1 | 25.58 (17.43) 1 |
Mortality, n (%) | 6 (25.00) | 9 (39.13) | 8 (38.10) | 17 (37.78) |
Variable | Allocation Group | Day 1 to Day 5 | Day 1 to Day 10 |
---|---|---|---|
TB, mg/dL | Group I | 0.84 (0.35)–1.08 (0.98) [n = 17] | 0.84 (0.35)–1.33 (1.31) [n = 14] |
Group II | 1.06 (1.14)–1.03 (1.21) [n = 23] | 1.04 (1.15)–0.84 (0.48) [n = 18] | |
Group III | 0.67 (0.32)–0.82 (0.69) [n = 17] | 0.72 (0.35)–0.93 (0.79) [n = 12] | |
AP, U/dL | Group I | 140.5 (105.81)–166.19 (141.47) [n = 17] | 114.31 (75.41)–140.92 (112.98) [n = 14] |
Group II | 141.30 (119.52)–152.04 (150.85) [n = 23] | 136.94 (130.39)–149.17 (168.34) [n = 18] | |
Group III | 108.94 (64.16)–135.65 (93.38) [n = 17] | 107.83 (62.14)–127.42 (50.11) [n = 12] | |
GGT, U/dL | Group I | 235.31 (217.66)–317.38 (246.88) [n = 17] | 217.85 (224.41)–281.15 (189.83) [n = 14] |
Group II | 275.30 (267.79)–275.30 (207.45) [n = 23] | 271.67 (289.13)–241.94 (161.18) [n = 18] | |
Group III | 180.18 (131.96)–317.59 (348.30) [n = 17] * | 190.67 (122.08)–304.67 (219.33) [n = 12] | |
TG, mg/dL | Group I | 282.88 (112.79)–292.65 (114.05) [n = 17] | 291.43 (118.65)–286.07 (96.38) [n = 14] |
Group II | 277.13 (143.50)–264.52 (111.47) [n = 23] | 297.28 (145.95)–244.22 (95.46) [n = 18] * | |
Group III | 222.41 (81.08)–225.76 (101.35) [n = 17] | 219.42 (91.53)–238.58 (139.39) [n = 12] |
Outcome | Variable | Odds Ratio (CI 95%) |
---|---|---|
Mortality (ITT) | APACHE II | 1.28 (1.10–1.48) * |
IL-6 (day 1) | 1.00 (1.00–1.00) | |
Mortality (PP) | APACHE II | 1.27 (1.10–1.47) * |
IL-6 (day 1) | 1.00 (1.00–1.00) | |
Outcome | Variable | Coefficient (CI 95%) |
ICU LOS (ITT) | APACHE II | 1.36 (0.05–2.67) * |
Age (years) | 0.58 (0.03–1.14) * | |
PN days | 0.97 (0.36–1.58) * | |
ICU LOS (ITT) | APACHE II | 1.58 (0.24–2.93) * |
PN days | 0.71 (0.13–1.29) * | |
O3FA g/kg/day | −81.25 (−146.28 to −16.23) * | |
Hospital LOS (ITT) | PN days | 1.43 (0.14–2.72) * |
Group II | −22.59 (−51.56–6.37) | |
Group III | −29.70 (−60.19 to −0.78) * | |
Hospital LOS (ITT) | PN days | 1.38 (0.15–2.60) * |
O3FA g/kg/day | −147.26 (−284.57 to −9.94) * | |
ICU LOS (PP) | APACHE II | 1.17 (−0.05 to 2.38) |
PN days | 0.80 (0.22–1.38) * | |
Group II | −9.22 (−21.99–3.54) | |
Group III | −19.97 (−33.67 to −6.28) * | |
ICU LOS (PP) | APACHE II | 1.19 (−0.01–2.40) |
PN days | 0.83 (0.28 –1.38) * | |
O3FA g/kg/day | −91.09 (−152.08 to −30.09)* | |
Hospital LOS (PP) | PN days | 1.61 (0.38–2.83) * |
Group II | −23.12 (−50.36–4.12) | |
Group III | −36.77 (−65.98 to −7.56) * | |
Hospital LOS (PP) | PN days | 1.60 (0.43–2.77) * |
Total O3FA g/kg/day | −167.6 (−298.67 to −37.05) * |
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Berlana, D.; Albertos, R.; Barquin, R.; Pau-Parra, A.; Díez-Poch, M.; López-Martínez, R.; Cea, C.; Cantenys-Molina, S.; Ferrer-Costa, R. Impact of Omega-3 Fatty Acid Supplementation in Parenteral Nutrition on Inflammatory Markers and Clinical Outcomes in Critically Ill COVID-19 Patients: A Randomized Controlled Trial. Nutrients 2024, 16, 3046. https://doi.org/10.3390/nu16183046
Berlana D, Albertos R, Barquin R, Pau-Parra A, Díez-Poch M, López-Martínez R, Cea C, Cantenys-Molina S, Ferrer-Costa R. Impact of Omega-3 Fatty Acid Supplementation in Parenteral Nutrition on Inflammatory Markers and Clinical Outcomes in Critically Ill COVID-19 Patients: A Randomized Controlled Trial. Nutrients. 2024; 16(18):3046. https://doi.org/10.3390/nu16183046
Chicago/Turabian StyleBerlana, David, Raquel Albertos, Raquel Barquin, Alba Pau-Parra, Monica Díez-Poch, Rocío López-Martínez, Cristina Cea, Sergi Cantenys-Molina, and Roser Ferrer-Costa. 2024. "Impact of Omega-3 Fatty Acid Supplementation in Parenteral Nutrition on Inflammatory Markers and Clinical Outcomes in Critically Ill COVID-19 Patients: A Randomized Controlled Trial" Nutrients 16, no. 18: 3046. https://doi.org/10.3390/nu16183046