Enteral glutamine supplements for patients with severe burns: A systematic review and meta-analysis

Purpose: Our previous study in 2009 concluded that glutamine may shorten the length of hospital stay (LOS) in patients with severe burns. Recent large-scale studies have suggested a decline in the effectiveness of glutamine in treating patients with severe burns over the last decade. Therefore, we conducted this systematic review and meta-analysis to update the status of glutamine uses in patients with severe burns. Methods: We retrieved related literature prior to December 2022 from the PubMed, Web of Science, Cochrane Library, Embase, SinoMed, Wanfang, and CNKI databases. Terms such as glutamine, enteral and burn were linked for searching. Adults patients with severe burns were included and non-randomized controlled trials were excluded. Data from studies that compared enteral glutamine for severe burns with a control group were extracted. The primary outcomes of mortality and infectious morbidities were pooled and analyzed. The modified Jadad scale and Cochrane collaboration''s tool were used to assess the risk of bias in RCTs, and the Review Manager 5.4 was used to pool and analyze the data. Results: Six randomized controlled trials involving 1398 patients were included in the analysis. There were no significant differences in overall mortality (risk ratio (RR) =0.37; 95% confidence interval (CI): 0.06 -2.37;p =0.300) or infectious morbidities (RR =0.73; 95%CI: 0.41 -1.31;p =0.290). The incidence of multiple organ dysfunction syndrome was similar between the 2 groups (RR =0.27; 95%CI: 0.03 -2.24;p =0.220). The LOS (mean difference (MD) =-8.97; 95%CI: -15.22 to -2.71;p =0.005) and LOS/total burn surface area (MD =-0.27; 95%CI: -0.54 to 0.00;p =0.050) decreased in the enteral glutamine group. The incidence of wound infection was significantly reduced (RR =0.42; 95%CI: 0.16 -1.06;p =0.070). Conclusion: Compared to the control group, enteral glutamine administration may not improve the mortality, although it may be associated with a shorter LOS, a lower LOS/total burn surface area ratio, and may reduce the risk of wound infection in patients with severe burns.