Nutritional supplement boosts immune response before cardiac surgery


LONDON (Reuters Health) – In high-risk patients, an immune-enhancing nutritional supplement given before elective cardiac surgery improves host defence and reduces postoperative infection, Dutch researchers report in the September 1st issue of The Lancet.

The oral supplement, which is conventionally used in critical care and given before cancer surgery, contains L-arginine, omega-3 polyunsaturated fatty acids and yeast RNA.

Dr. Robert Tepaske from the Academic Medical Center, Amsterdam, and colleagues randomly assigned 50 patients to the nutritional supplement or placebo before they underwent cardiac surgery. The patients were at least 70 years of age, had ejection fraction <0.40, and/or were to undergo mitral valve replacement. Five patients were ultimately excluded from the study because of changes in the operation programme.

Those assigned to the nutritional supplement drank 5 L to 10 L per day for 5 to 10 days before surgery. Before surgery, these patients had significantly higher expression of HLA-DR epitopes on monocytes compared with controls (p = 0.02), which in previous studies has been shown to correlate with better outcome after cardiac surgery.

Postoperatively, 4 of 23 patients in the nutritional supplement group had infection compared with 12 of the 22 patients who received placebo (p = 0.01), Dr. Tepaske's group found. On postoperative day 2, creatine clearance was significantly greater in the treatment group (p = 0.03).

"These beneficial effects support use of an oral immune-enhancing nutritional supplement in patients who are undergoing cardiac surgery and are at high risk of infection," Dr. Tepaske and colleagues conclude.

Lancet 2001;358:696-701.

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