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Effect of preoperative oral immune-enhancing nutritional supplement on patients at high risk of infection after cardiac surgery: a randomised placebo-controlled trial.

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Title: Effect of preoperative oral immune-enhancing nutritional supplement on patients at high risk of infection after cardiac surgery: a randomised placebo-controlled trial.
Authors: Tepaske R (AUTHOR), te Velthuis H (AUTHOR), Oudemans-van Straaten HM (AUTHOR), Heisterkamp SH (AUTHOR), van Deventer SJH (AUTHOR), Ince C (AUTHOR), Eÿsman L (AUTHOR), Kesecioglu J (AUTHOR), Tepaske, R (AUTHOR), Velthuis, H (AUTHOR), Oudemans-van Straaten, H M (AUTHOR), Heisterkamp, S H (AUTHOR), van Deventer, S J (AUTHOR), Ince, C (AUTHOR), Eÿsman, L (AUTHOR), Kesecioglu, J (AUTHOR)
Source: Lancet. 9/1/2001, Vol. 358 Issue 9283, p696-701. 6p.
Abstract: Background: Elderly patients and those with poor ventricular function have increased morbidity and mortality rates when undergoing surgery. We aimed to ascertain whether an oral immune-enhancing nutritional supplement could improve preoperative host defence, and subsequently lower postoperative infections and organ dysfunction in patients undergoing elective cardiac surgery who are at high risk of infection.Methods: In this prospective, randomised, double-blind, placebo-controlled study, we randomly assigned 50 patients who were scheduled to undergo coronary artery bypass to receive either an oral immune-enhancing nutritional supplement containing L-arginine, omega3 polyunsaturated fatty acids, and yeast RNA (n=25), or a control (n=25) for a minimum of 5 days. Patients were included if they were aged 70 years or older, or had an ejection fraction of less than 0.4, or were scheduled to undergo mitral valve replacement. The main outcome was preoperative host defence (delayed-type hypersensitivity response to recall antigens, expression of HLA-DR epitopes on monocytes, and concentration of interleukin 6 in plasma). Analysis was per protocol.Findings: Five patients (two in the treatment group) were excluded because they did not take the minimum dose. Preoperative expression of HLA-DR epitopes on monocytes was significantly higher in patients given the study treatment (109% [95% CI 92-128]) than those given the control (69% [58-82]) compared with baseline (100%) (p=0.02, repeated measures ANOVA). However, concentration of interleukin 6 was significantly lower in the treatment group (0.90 pg/L [0.69-1.18]) than in the control group (1.94 pg/L [1.45-2.59]) (p=0.032, repeated measures ANOVA). Additionally, delayed-type hypersensitivity response to recall antigens improved preoperatively and remained better until hospital discharge.Interpretation: Intake of an oral immune-enhancing nutritional supplement for a minimum of 5 days before surgery can improve outlook in high-risk patients who are undergoing elective cardiac surgery. [ABSTRACT FROM AUTHOR]
Copyright of Lancet is the property of Lancet and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Effect of preoperative oral immune-enhancing nutritional supplement on patients at high risk of infection after cardiac surgery: a randomised placebo-controlled trial.
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  Data: <searchLink fieldCode="AR" term="%22Tepaske+R%22">Tepaske R</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22te+Velthuis+H%22">te Velthuis H</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Oudemans-van+Straaten+HM%22">Oudemans-van Straaten HM</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Heisterkamp+SH%22">Heisterkamp SH</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22van+Deventer+SJH%22">van Deventer SJH</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Ince+C%22">Ince C</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Eÿsman+L%22">Eÿsman L</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Kesecioglu+J%22">Kesecioglu J</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Tepaske%2C+R%22">Tepaske, R</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Velthuis%2C+H%22">Velthuis, H</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Oudemans-van+Straaten%2C+H+M%22">Oudemans-van Straaten, H M</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Heisterkamp%2C+S+H%22">Heisterkamp, S H</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22van+Deventer%2C+S+J%22">van Deventer, S J</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Ince%2C+C%22">Ince, C</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Eÿsman%2C+L%22">Eÿsman, L</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Kesecioglu%2C+J%22">Kesecioglu, J</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22Lancet%22">Lancet</searchLink>. 9/1/2001, Vol. 358 Issue 9283, p696-701. 6p.
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  Data: <bold>Background: </bold>Elderly patients and those with poor ventricular function have increased morbidity and mortality rates when undergoing surgery. We aimed to ascertain whether an oral immune-enhancing nutritional supplement could improve preoperative host defence, and subsequently lower postoperative infections and organ dysfunction in patients undergoing elective cardiac surgery who are at high risk of infection.<bold>Methods: </bold>In this prospective, randomised, double-blind, placebo-controlled study, we randomly assigned 50 patients who were scheduled to undergo coronary artery bypass to receive either an oral immune-enhancing nutritional supplement containing L-arginine, omega3 polyunsaturated fatty acids, and yeast RNA (n=25), or a control (n=25) for a minimum of 5 days. Patients were included if they were aged 70 years or older, or had an ejection fraction of less than 0.4, or were scheduled to undergo mitral valve replacement. The main outcome was preoperative host defence (delayed-type hypersensitivity response to recall antigens, expression of HLA-DR epitopes on monocytes, and concentration of interleukin 6 in plasma). Analysis was per protocol.<bold>Findings: </bold>Five patients (two in the treatment group) were excluded because they did not take the minimum dose. Preoperative expression of HLA-DR epitopes on monocytes was significantly higher in patients given the study treatment (109% [95% CI 92-128]) than those given the control (69% [58-82]) compared with baseline (100%) (p=0.02, repeated measures ANOVA). However, concentration of interleukin 6 was significantly lower in the treatment group (0.90 pg/L [0.69-1.18]) than in the control group (1.94 pg/L [1.45-2.59]) (p=0.032, repeated measures ANOVA). Additionally, delayed-type hypersensitivity response to recall antigens improved preoperatively and remained better until hospital discharge.<bold>Interpretation: </bold>Intake of an oral immune-enhancing nutritional supplement for a minimum of 5 days before surgery can improve outlook in high-risk patients who are undergoing elective cardiac surgery. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Lancet is the property of Lancet and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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