Omega-3 supplementation in patients with sepsis: a systematic review and meta-analysis of randomized trials

Annals of Intensive Care

Table 2 Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence profile

Quality assessment						No. of patients		Effect		Quality
No. of studies	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	Omega-3 supplementation	Control	Relative (95% CI)	Absolute (95% CI)	Quality
Mortality
17	Not serious	Not serious	Serious^a	Not serious^b	None	149/629 (23.7%)	161/610 (26.4%)	RR 0.85 (0.71 to 1.03)	40 fewer per 1000 (from 8 more to 77 fewer)	Moderate
ICU length of stay
12	Serious^c	Serious^d	Serious^a	Not serious	None	469	456	–	MD 3.79 days fewer (5.49 fewer to 2.09 fewer)	Very low
Duration of mechanical ventilation
7	Serious^c	Serious^e	Serious^a	Not serious	None	254	241	–	MD 2.27 days fewer (4.27 fewer to 0.27 fewer)	Very low

CI confidence interval, RR relative risk, MD mean difference
^aWe rated down the quality of evidence by one level for multiple sources of indirectness. Population: mechanical ventilation and sepsis severity varied as inclusion criteria across studies. Intervention: content of enteral/parenteral formulations differed across studies (10 used fish oil alone while 7 used formulae with additional supplements such as mRNA, arginine, and selenium). Outcome: different mortality definitions (28-day, 60-day, in-hospital, ICU)
^bWe did not rate down the quality of evidence for imprecision. The CI included both significant benefit and small harm, but the number of events was not small
^cWe rated down the quality of evidence by one level for risk of bias. Several studies showed high risk of attrition bias and performance bias
^dWe rated down the quality of evidence by one level for significant unexplained heterogeneity (P < 0.00001, I ² = 82%)
^eWe rated down the quality of evidence by one level for significant unexplained heterogeneity (P = 0.02, I ² = 60%)