Interaction Between 2 Nutraceutical Treatments and Host Immune Status in the Pediatric Critical Illness Stress-Induced Immune Suppression Comparative Effectiveness Trial

Joseph A. Carcillo*, J. Michael Dean, Richard Holubkov, John Berger, Kathleen L. Meert, Kanwaljeet J.S. Anand, Jerry J. Zimmerman, Christopher J.L. Newth, Rick Harrison, Jeri Burr, Douglas F. Willson, Carol Nicholson, Michael J. Bell, Robert A. Berg, Thomas P. Shanley, Sabrina M. Heidemann, Heidi Dalton, Tammara L. Jenkins, Allan Doctor, Angie WebsterRobert F. Tamburro, for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Collaborative Pediatric Critical Care Research Network (CPCCRN)

*Corresponding author for this work

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background and aims: The pediatric Critical Illness Stress-induced Immune Suppression (CRISIS) trial compared the effectiveness of 2 nutraceutical supplementation strategies and found no difference in the development of nosocomial infection and sepsis in the overall population. We performed an exploratory post hoc analysis of interaction between nutraceutical treatments and host immune status related to the development of nosocomial infection/sepsis. Methods: Children from the CRISIS trial were analyzed according to 3 admission immune status categories marked by decreasing immune competence: immune competent without lymphopenia, immune competent with lymphopenia, and previously immunocompromised. The comparative effectiveness of the 2 treatments was analyzed for interaction with immune status category. Results: There were 134 immune-competent children without lymphopenia, 79 previously immune-competent children with lymphopenia, and 27 immunocompromised children who received 1 of the 2 treatments. A significant interaction was found between treatment arms and immune status on the time to development of nosocomial infection and sepsis (P <.05) and on the rate of nosocomial infection and sepsis per 100 patient days (P <.05). Whey protein treatment protected immune-competent patients without lymphopenia from infection and sepsis, both nutraceutical strategies were equivalent in immune-competent patients with lymphopenia, and zinc, selenium, glutamine, and metoclopramide treatment protected immunocompromised patients from infection and sepsis. Conclusions: The science of immune nutrition is more complex than previously thought. Future trial design should consider immune status at the time of trial entry because differential effects of nutraceuticals may be related to this patient characteristic.

Original languageEnglish (US)
Pages (from-to)1325-1335
Number of pages11
JournalJournal of Parenteral and Enteral Nutrition
Volume41
Issue number8
DOIs
StatePublished - Nov 1 2017

Fingerprint

Lymphopenia
Dietary Supplements
Critical Illness
Sepsis
Pediatrics
Cross Infection
Therapeutics
Nutritional Sciences
Metoclopramide
Immunocompromised Host
Selenium
Infection
Glutamine
Mental Competency
Zinc
Population

Keywords

  • immune status
  • nosocomial infection
  • nutraceutical

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

Carcillo, J. A., Dean, J. M., Holubkov, R., Berger, J., Meert, K. L., Anand, K. J. S., ... for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Collaborative Pediatric Critical Care Research Network (CPCCRN) (2017). Interaction Between 2 Nutraceutical Treatments and Host Immune Status in the Pediatric Critical Illness Stress-Induced Immune Suppression Comparative Effectiveness Trial. Journal of Parenteral and Enteral Nutrition, 41(8), 1325-1335. https://doi.org/10.1177/0148607116670377
Carcillo, Joseph A. ; Dean, J. Michael ; Holubkov, Richard ; Berger, John ; Meert, Kathleen L. ; Anand, Kanwaljeet J.S. ; Zimmerman, Jerry J. ; Newth, Christopher J.L. ; Harrison, Rick ; Burr, Jeri ; Willson, Douglas F. ; Nicholson, Carol ; Bell, Michael J. ; Berg, Robert A. ; Shanley, Thomas P. ; Heidemann, Sabrina M. ; Dalton, Heidi ; Jenkins, Tammara L. ; Doctor, Allan ; Webster, Angie ; Tamburro, Robert F. ; for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Collaborative Pediatric Critical Care Research Network (CPCCRN). / Interaction Between 2 Nutraceutical Treatments and Host Immune Status in the Pediatric Critical Illness Stress-Induced Immune Suppression Comparative Effectiveness Trial. In: Journal of Parenteral and Enteral Nutrition. 2017 ; Vol. 41, No. 8. pp. 1325-1335.
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abstract = "Background and aims: The pediatric Critical Illness Stress-induced Immune Suppression (CRISIS) trial compared the effectiveness of 2 nutraceutical supplementation strategies and found no difference in the development of nosocomial infection and sepsis in the overall population. We performed an exploratory post hoc analysis of interaction between nutraceutical treatments and host immune status related to the development of nosocomial infection/sepsis. Methods: Children from the CRISIS trial were analyzed according to 3 admission immune status categories marked by decreasing immune competence: immune competent without lymphopenia, immune competent with lymphopenia, and previously immunocompromised. The comparative effectiveness of the 2 treatments was analyzed for interaction with immune status category. Results: There were 134 immune-competent children without lymphopenia, 79 previously immune-competent children with lymphopenia, and 27 immunocompromised children who received 1 of the 2 treatments. A significant interaction was found between treatment arms and immune status on the time to development of nosocomial infection and sepsis (P <.05) and on the rate of nosocomial infection and sepsis per 100 patient days (P <.05). Whey protein treatment protected immune-competent patients without lymphopenia from infection and sepsis, both nutraceutical strategies were equivalent in immune-competent patients with lymphopenia, and zinc, selenium, glutamine, and metoclopramide treatment protected immunocompromised patients from infection and sepsis. Conclusions: The science of immune nutrition is more complex than previously thought. Future trial design should consider immune status at the time of trial entry because differential effects of nutraceuticals may be related to this patient characteristic.",
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author = "Carcillo, {Joseph A.} and Dean, {J. Michael} and Richard Holubkov and John Berger and Meert, {Kathleen L.} and Anand, {Kanwaljeet J.S.} and Zimmerman, {Jerry J.} and Newth, {Christopher J.L.} and Rick Harrison and Jeri Burr and Willson, {Douglas F.} and Carol Nicholson and Bell, {Michael J.} and Berg, {Robert A.} and Shanley, {Thomas P.} and Heidemann, {Sabrina M.} and Heidi Dalton and Jenkins, {Tammara L.} and Allan Doctor and Angie Webster and Tamburro, {Robert F.} and {for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Collaborative Pediatric Critical Care Research Network (CPCCRN)}",
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Carcillo, JA, Dean, JM, Holubkov, R, Berger, J, Meert, KL, Anand, KJS, Zimmerman, JJ, Newth, CJL, Harrison, R, Burr, J, Willson, DF, Nicholson, C, Bell, MJ, Berg, RA, Shanley, TP, Heidemann, SM, Dalton, H, Jenkins, TL, Doctor, A, Webster, A, Tamburro, RF & for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Collaborative Pediatric Critical Care Research Network (CPCCRN) 2017, 'Interaction Between 2 Nutraceutical Treatments and Host Immune Status in the Pediatric Critical Illness Stress-Induced Immune Suppression Comparative Effectiveness Trial', Journal of Parenteral and Enteral Nutrition, vol. 41, no. 8, pp. 1325-1335. https://doi.org/10.1177/0148607116670377

Interaction Between 2 Nutraceutical Treatments and Host Immune Status in the Pediatric Critical Illness Stress-Induced Immune Suppression Comparative Effectiveness Trial. / Carcillo, Joseph A.; Dean, J. Michael; Holubkov, Richard; Berger, John; Meert, Kathleen L.; Anand, Kanwaljeet J.S.; Zimmerman, Jerry J.; Newth, Christopher J.L.; Harrison, Rick; Burr, Jeri; Willson, Douglas F.; Nicholson, Carol; Bell, Michael J.; Berg, Robert A.; Shanley, Thomas P.; Heidemann, Sabrina M.; Dalton, Heidi; Jenkins, Tammara L.; Doctor, Allan; Webster, Angie; Tamburro, Robert F.; for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Collaborative Pediatric Critical Care Research Network (CPCCRN).

In: Journal of Parenteral and Enteral Nutrition, Vol. 41, No. 8, 01.11.2017, p. 1325-1335.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Interaction Between 2 Nutraceutical Treatments and Host Immune Status in the Pediatric Critical Illness Stress-Induced Immune Suppression Comparative Effectiveness Trial

AU - Carcillo, Joseph A.

AU - Dean, J. Michael

AU - Holubkov, Richard

AU - Berger, John

AU - Meert, Kathleen L.

AU - Anand, Kanwaljeet J.S.

AU - Zimmerman, Jerry J.

AU - Newth, Christopher J.L.

AU - Harrison, Rick

AU - Burr, Jeri

AU - Willson, Douglas F.

AU - Nicholson, Carol

AU - Bell, Michael J.

AU - Berg, Robert A.

AU - Shanley, Thomas P.

AU - Heidemann, Sabrina M.

AU - Dalton, Heidi

AU - Jenkins, Tammara L.

AU - Doctor, Allan

AU - Webster, Angie

AU - Tamburro, Robert F.

AU - for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Collaborative Pediatric Critical Care Research Network (CPCCRN)

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Background and aims: The pediatric Critical Illness Stress-induced Immune Suppression (CRISIS) trial compared the effectiveness of 2 nutraceutical supplementation strategies and found no difference in the development of nosocomial infection and sepsis in the overall population. We performed an exploratory post hoc analysis of interaction between nutraceutical treatments and host immune status related to the development of nosocomial infection/sepsis. Methods: Children from the CRISIS trial were analyzed according to 3 admission immune status categories marked by decreasing immune competence: immune competent without lymphopenia, immune competent with lymphopenia, and previously immunocompromised. The comparative effectiveness of the 2 treatments was analyzed for interaction with immune status category. Results: There were 134 immune-competent children without lymphopenia, 79 previously immune-competent children with lymphopenia, and 27 immunocompromised children who received 1 of the 2 treatments. A significant interaction was found between treatment arms and immune status on the time to development of nosocomial infection and sepsis (P <.05) and on the rate of nosocomial infection and sepsis per 100 patient days (P <.05). Whey protein treatment protected immune-competent patients without lymphopenia from infection and sepsis, both nutraceutical strategies were equivalent in immune-competent patients with lymphopenia, and zinc, selenium, glutamine, and metoclopramide treatment protected immunocompromised patients from infection and sepsis. Conclusions: The science of immune nutrition is more complex than previously thought. Future trial design should consider immune status at the time of trial entry because differential effects of nutraceuticals may be related to this patient characteristic.

AB - Background and aims: The pediatric Critical Illness Stress-induced Immune Suppression (CRISIS) trial compared the effectiveness of 2 nutraceutical supplementation strategies and found no difference in the development of nosocomial infection and sepsis in the overall population. We performed an exploratory post hoc analysis of interaction between nutraceutical treatments and host immune status related to the development of nosocomial infection/sepsis. Methods: Children from the CRISIS trial were analyzed according to 3 admission immune status categories marked by decreasing immune competence: immune competent without lymphopenia, immune competent with lymphopenia, and previously immunocompromised. The comparative effectiveness of the 2 treatments was analyzed for interaction with immune status category. Results: There were 134 immune-competent children without lymphopenia, 79 previously immune-competent children with lymphopenia, and 27 immunocompromised children who received 1 of the 2 treatments. A significant interaction was found between treatment arms and immune status on the time to development of nosocomial infection and sepsis (P <.05) and on the rate of nosocomial infection and sepsis per 100 patient days (P <.05). Whey protein treatment protected immune-competent patients without lymphopenia from infection and sepsis, both nutraceutical strategies were equivalent in immune-competent patients with lymphopenia, and zinc, selenium, glutamine, and metoclopramide treatment protected immunocompromised patients from infection and sepsis. Conclusions: The science of immune nutrition is more complex than previously thought. Future trial design should consider immune status at the time of trial entry because differential effects of nutraceuticals may be related to this patient characteristic.

KW - immune status

KW - nosocomial infection

KW - nutraceutical

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