Severe acute pancreatitis treated in 11 ways by Omega-3 in just 7 days – RCT April 2018

Intravenous omega-3 fatty acids are associated with better clinical outcome and less inflammation in patients with predicted severe acute pancreatitis:A randomised double blind controlled trial

Clinical Nutrition DOI: https://doi.org/10.1016/j.clnu.2018.04.003
D. Al-Leswas. dhya at doctros.org.uk., A.M. Eltweri, W.-Y. Chung, A. Arshad, J.A. Stephenson, O. Al-Taan, C. Pollard, H.L. Fisk, P.C. Calder, G. Garcea, M.S. Metcalfe, A.R. Dennison

Background and aims
Omega-3 fatty acids (FA) can ameliorate the hyper-inflammatory response that occurs in conditions such as severe acute pancreatitis (SAP) and this may improve clinical outcome. We tested the hypothesis that parenteral omega-3 FA from a lipid emulsion that includes fish oil could be beneficial in patients with predicted SAP by reducing C-reactive protein (CRP) concentration (primary outcome), and modulating the inflammatory response and improving clinical outcome (secondary outcomes).

Methods
In a phase II randomized double‐blind single-centre controlled trial, patients with predicted SAP were randomised to receive a daily infusion of fish oil containing lipid emulsion (Lipidem® 20%, BBraun) for 7 days (n=23) or a daily infusion of a lipid emulsion without fish oil (Lipofundin® MCT 20%, BBraun) (n=22).

Results
On admission, both groups had comparable pancreatitis predicted severity and APACHE II scores. Administration of fish oil resulted in

• lower total blood leukocyte number (P=0.04), CRP (P=0.013),
• interleukin-8 (P=0.05) and
• intercellular adhesion molecule 1 (P=0.01) concentrations,
• multiple organ dysfunction score,
• sequential organ failure assessment score (P=0.004),
• early warning score (P=0.01), and
• systemic inflammatory response syndrome (P=0.03)

compared to the control group.
The fish oil group had

• fewer new organ failures (P=0.07),
• lower critical care admission rate (P=0.06).,
• shorter critical care stay (P=0.03) and
• shorter total hospital stay (P=0.04).

Conclusions
It is concluded that intravenous administration of a fish oil containing lipid emulsion, a source of omega-3 FA, improves clinical outcomes in patients with predicted SAP, benefits that may be linked to reduced inflammation.

Abbreviations used:
CRP (C-reactive protein), DHA (docosahexenoic acid), EPA (eicosapentenoic acid), EWS (early warning score), SIRS (systemic inflammatory response syndrome), FA (fatty acid), ICAM‐1 (intercellular adhesion molecule‐1), IL (interleukin), MCT (medium chain triglyceride), MODS (multiple organ dysfunction score), PC (phosphatidylcholine), SOFA (sequential organ failure assessment)