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Fig. 1 | Annals of Intensive Care

Fig. 1

From: Glutamine, fish oil and antioxidants in critical illness: MetaPlus trial post hoc safety analysis

Fig. 1

Illustration of causal step approach for changes in (epa + dha)/lcf plasma level ratio from baseline to day 4 as mediator for treatment effect. IMHP immune-modulating high-protein enteral nutrition, HP high-protein enteral nutrition, A, B, C, C′ association path. Method based on: Baron and Kenny [13]. For mediator analyses, it is important not only that a given treatment (IMHP vs. HP) is associated with the outcome (6-month mortality), but also that the treatment induces changes in mediator plasma concentrations (association path A) and that these changes are associated with the outcome (association path B). In case a potential mediator is inserted into multivariate analysis (Model II), the effect of the treatment (C′) should disappear. In other words, the treatment induces statistical significant changes in the outcome (6-month mortality increase) through an increase in plasma levels, these increases in plasma levels are associated with the increased 6-month mortality, and this effect is mediated through the treatment and not due to other factors

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