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Clinical Trial
, 47 (2), 600-614

The Effects of ω-3 Fish Oil Emulsion-Based Parenteral Nutrition Plus Combination Treatment for Acute Paraquat Poisoning

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Clinical Trial

The Effects of ω-3 Fish Oil Emulsion-Based Parenteral Nutrition Plus Combination Treatment for Acute Paraquat Poisoning

Zhaohua Meng et al. J Int Med Res.

Abstract

Objective: To investigate the effects of parenteral nutrition (PN) including ω-3 fish-oil emulsion on nutritional state, inflammatory response, and prognosis in patients with acute paraquat poisoning.

Methods: Patients randomized to receive medium chain triglycerides (MCT)/long chain triglycerides (LCT)-based PN (control group) or MCT/LCT-based PN containing ω-3 fish-oil emulsion (intervention group) were compared for 90-day survival and short-term treatment efficacy.

Results: Tumour necrosis factor-α levels were significantly lower in the intervention group ( n = 101) versus controls ( n = 73) on treatment days 4 and 7. Intervention group C-reactive protein (CRP) levels were significantly increased on day 4, decreased to baseline (day 1) levels on day 7, and were significantly lower than baseline on day 10. Control group CRP levels were significantly increased on days 4 and 7 versus baseline, and returned to baseline levels on day 10. On day 7, retinol binding protein had recovered to baseline levels in the intervention group only. Intervention group mortality rate (36.6%) was significantly lower than controls (57.5%). ω-3 fish-oil PN was associated with reduced risk of death (hazard ratio 0.52; 95% confidence interval 0.33, 0.82).

Conclusion: In patients with acute paraquat poisoning, MCT/LCT with ω-3 fish-oil emulsion PN plus combination treatment advantageously attenuated the inflammatory response, modified the nutritional state, and was associated with significantly improved 90-day survival versus treatment without ω-3 fish oil.

Keywords: Paraquat poisoning; combination treatment; inflammatory factors; ω-3 fish oil fat emulsion.

Figures

Figure 1.
Figure 1.
Study flow diagram showing selection and randomization to treatment with 0.4 g/kg lipofundin 20% MCT/LCT-based emulsion plus 0.2 g/kg ω-3 fish-oil emulsion (intervention group) or 0.6 g/kg lipofundin 20% MCT/LCT-based emulsion (control group) in patients with acute paraquat poisoning; MCT, medium chain triglycerides; LCT, long chain triglycerides
Figure 2.
Figure 2.
Comparison of total lymphocyte count (TLC) between patients with acute paraquat poisoning treated with 0.4 g/kg lipofundin 20% MCT/LCT-based emulsion plus 0.2 g/kg ω-3 fish-oil emulsion (intervention group) or 0.6 g/kg lipofundin 20% MCT/LCT-based emulsion (control group), and within-group comparisons on each day following initiation of treatment: *P < 0.05 versus baseline values (intragroup comparison using Student's t-test); No statistically significant differences between the two groups on each treatment day; MCT, medium chain triglycerides; LCT, long chain triglycerides
Figure 3.
Figure 3.
Comparison of tumour necrosis factor (TNF)-α levels between patients with acute paraquat poisoning treated with 0.4 g/kg lipofundin 20% MCT/LCT-based emulsion plus 0.2 g/kg ω-3 fish-oil emulsion (intervention group) or 0.6 g/kg lipofundin 20% MCT/LCT-based emulsion (control group), and within-group comparisons on each day following initiation of treatment: #P < 0.05, between-group differences at days 4 and 7; *P < 0.05, versus baseline (all Student's t-test); MCT, medium chain triglycerides; LCT, long chain triglycerides
Figure 4.
Figure 4.
Comparison of C-reactive protein (CRP) levels between patients with acute paraquat poisoning treated with 0.4 g/kg lipofundin 20% MCT/LCT-based emulsion plus 0.2 g/kg ω-3 fish-oil emulsion (intervention group) or 0.6 g/kg lipofundin 20% MCT/LCT-based emulsion (control group), and within-group comparisons on each day following initiation of treatment: #P < 0.05, between-group differences at days 7 and 10; *P < 0.05, versus baseline (all Student's t-test); MCT, medium chain triglycerides; LCT, long chain triglycerides
Figure 5.
Figure 5.
Comparison of retinol binding protein (RBP) levels between patients with acute paraquat poisoning treated with 0.4 g/kg lipofundin 20% MCT/LCT-based emulsion plus 0.2 g/kg ω-3 fish-oil emulsion (intervention group) or 0.6 g/kg lipofundin 20% MCT/LCT-based emulsion (control group), and within-group comparisons on each day following initiation of treatment: #P < 0.05, between-group differences at days 1 and 7; *P < 0.05, versus baseline; P < 0.05, day 4 versus day 7 (all Student’s t-test); MCT, medium chain triglycerides; LCT, long chain triglycerides
Figure 6.
Figure 6.
Comparison of prealbumin (PA) levels between patients with acute paraquat poisoning treated with 0.4 g/kg lipofundin 20% MCT/LCT-based emulsion plus 0.2 g/kg ω-3 fish-oil emulsion (intervention group) or 0.6 g/kg lipofundin 20% MCT/LCT-based emulsion (control group), and within-group comparisons on each day following initiation of treatment: There were no statistically significant between-group or within-group differences (Student's t-test)
Figure 7.
Figure 7.
Kaplan-Meier estimates of the probability of survival at 90 days between patients with acute paraquat poisoning treated with 0.4 g/kg lipofundin 20% MCT/LCT-based emulsion plus 0.2 g/kg ω-3 fish-oil emulsion (intervention group) or 0.6 g/kg lipofundin 20% MCT/LCT-based emulsion (control group): Hazard ratio 0.522, 95% confidence interval 0.332, 0.820 (P = 0.005)

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