The effectiveness of probiotics or synbiotics in the prevention and treatment of diarrhea among critically ill adults: A systematic review and meta-analysis

Background and objective: Diarrhea is one of the most common complications among patients in the Intensive Care Unit (ICU). Alongside common medical products for managing diarrhea, attention has been directed toward natural approaches, such as the use of probiotics or synbiotics supplements. The purpose of this review is to evaluate the effectiveness of probiotics or synbiotics in the prevention and treatment of diarrhea, mortality, and length of ICU stay. Methods: In adherence to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) statement, a systematic review and meta-analysis was conducted. Relevant articles were identified by searching PubMed, SpringerLink, and ScienceDirect databases. Quality assessment was done using Cochrane Collaboration's tool for randomized-controlled trials (ROB2). Results: 6305 articles were identified, of which 14 papers were included. Probiotics reduced the risk of diarrhea by 10 %; however, the result was not statistically significant [Risk Ratio (RR) = 0.90; 95 % Confidence Interval (CI): 0.77 to 1.05; P = 0.16; I2 = 29 %; 13 studies]. No statistical significance was found among studies regarding reducing the duration of diarrhea, with considerable heterogeneity [RR =0.53; 95 % CI:-1.46 to 0.41; P = 0.27; I2 = 71 %, 5 studies]. Neither the length of ICU stays nor the mortality rate was affected by the use of probiotics or synbiotics. Conclusion: Probiotics or synbiotics appear to slightly reduce the incidence of diarrhea among ICU patients. However, this effect is considered statistically significant only after conducting sensitivity and subgroup analyses. Further high-quality clinical trials are required to evaluate the potential of probiotics or synbiotics in the treatment of diarrhea among critically ill patients. (c) 2024 The Author(s). Published by Elsevier Ltd on behalf of European Society for Clinical Nutrition and Metabolism. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).