Pei Hui, Qu Jie, Chen Jian-Ming, Zhang Yao-Lu, Zhang Min, Zhao Guang-Ju, Lu Zhong-Qiu
Emergency Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
Wenzhou Key Laboratory of Emergency and Disaster Medicine, Wenzhou, 325000, China.
Heliyon. 2024 Apr 4;10(8):e29156. doi: 10.1016/j.heliyon.2024.e29156. eCollection 2024 Apr 30.
The occurrence and development of sepsis are related to the excessive production of oxygen free radicals and the weakened natural clearance mechanism. Further dependable evidence is required to clarify the effectiveness of antioxidant therapy, especially its impact on short-term mortality.
The purpose of this systematic review and meta-analysis was to evaluate the effect of common antioxidant therapy on short-term mortality in patients with sepsis.
According to PRISMA guidelines, a systematic literature search on antioxidants in adults sepsis patients was performed on PubMed/Medline, Embase, and the Cochrane Library from the establishment of the database to November 2023. Antioxidant supplements can be a single-drug or multi-drug combination: HAT (hydrocortisone, ascorbic acid, and thiamine), ascorbic acid, thiamine, N-acetylcysteine and selenium. The primary outcome was the effect of antioxidant treatment on short-term mortality, which included 28-day mortality, in-hospital mortality, intensive care unit mortality, and 30-day mortality. Subgroup analyses of short-term mortality were used to reduce statistical heterogeneity and publication bias.
Sixty studies of 130,986 sepsis patients fulfilled the predefined criteria and were quantified and meta-analyzed. Antioxidant therapy reduces the risk of short-term death in sepsis patients by multivariate meta-analysis of current data, including a reduction of in-hospital mortality ( = 0.81, 0.67 to 0.99; 0.040) and 28-day mortality ( = 0.81, 0.69 to 0.95]; 0.008). Particularly in subgroup analyses, ascorbic acid treatment can reduce in-hospital mortality ( = 0.66, 0.90 to 0.98; = 0.006) and 28-day mortality ( = 0.43, 0.24 to 0.75; = 0.003). However, the meta-analysis of RCTs found that antioxidant therapy drugs, especially ascorbic acid, did substantially reduce short-term mortality( = 0.78, 0.62 to 0.98; = 0.030; = 0.57, 0.36 to 0.91; = 0.020).
According to current data of RCTs, antioxidant therapy, especially ascorbic acid, has a trend of improving short-term mortality in patients with sepsis, but the evidence remains to be further demonstrated.
脓毒症的发生和发展与氧自由基的过度产生以及自然清除机制减弱有关。需要进一步可靠的证据来阐明抗氧化治疗的有效性，尤其是其对短期死亡率的影响。
本系统评价和荟萃分析的目的是评估常见抗氧化治疗对脓毒症患者短期死亡率的影响。
根据PRISMA指南，从数据库建立至2023年11月，在PubMed/Medline、Embase和Cochrane图书馆对成人脓毒症患者使用抗氧化剂进行了系统文献检索。抗氧化补充剂可以是单一药物或多药物组合：氢化可的松、抗坏血酸和硫胺素（HAT）、抗坏血酸、硫胺素、N-乙酰半胱氨酸和硒。主要结局是抗氧化治疗对短期死亡率的影响，包括28天死亡率、住院死亡率、重症监护病房死亡率和30天死亡率。对短期死亡率进行亚组分析以减少统计异质性和发表偏倚。
对130986例脓毒症患者的60项研究符合预定义标准，并进行了量化和荟萃分析。通过对当前数据的多变量荟萃分析，抗氧化治疗降低了脓毒症患者短期死亡风险，包括降低住院死亡率（RR=0.81，95%CI：0.67至0.99；P=0.040）和28天死亡率（RR=0.81，95%CI：0.69至0.95；P=0.008）。特别是在亚组分析中，抗坏血酸治疗可降低住院死亡率（RR=0.66，95%CI：0.90至0.98；P=0.006）和28天死亡率（RR=0.43，95%CI：0.24至0.75；P=0.003）。然而，随机对照试验的荟萃分析发现，抗氧化治疗药物，尤其是抗坏血酸，并未显著降低短期死亡率（RR=0.78，95%CI：0.62至0.98；P=0.030；I²=0.57，95%CI：0.36至0.91；P=0.020）。
根据目前随机对照试验的数据，抗氧化治疗，尤其是抗坏血酸，有改善脓毒症患者短期死亡率的趋势，但证据仍有待进一步证实。
