Efficacy and safety of acupuncture for septic gastrointestinal dysfunction: A systematic review and meta-analysis of randomized controlled trials

Abstract

ABSTRACT Background Septic gastrointestinal dysfunction (S-GID) lacks effective therapeutic approaches. Acupuncture has been widely applied for treating S-GID, however, its efficacy and safety lack high-quality evidence-based support, particularly those from randomized controlled trials (RCTs). Methods: A comprehensive search in PubMed, Embase, The Cochrane Library and the other four Chinese databases were searched from all years up to September 2023 of acupuncture for S-GID. Additionally, research progress was reviewed in the Chinese Clinical Trials Registry and ClinicalTrials.gov. Analysis was undertaken using RevMan5.3 and STAT13.1. Continuous data was evaluated the mean difference (MD)/the standard mean difference (SMD) and 95% confidence intervals (CIs). Dichotomous data was calculated the relative risk (RR)/the odds ratio (OR) with 95% CI. The quality of the data was assessed using the Risk of Bias Tool 2 and the GRADEpro GDT tool. Results: Thirteen RCTs with 865 patients were included for the analysis. Compared with the group of the standard treatment, the combination of acupuncture and the standard treatment for S-GID effectively reduced the intra-abdominal pressure (IAP; SMD = –0.71; 95% CI: –1.01, –0.41, P < 0.001), the acute gastrointestinal injury grade (AGI; MD = –0.44; 95% CI: –0.65 to –0.23; P < 0.001), the Acute Physiology and Chronic Health Evaluation-II score (APACHE-II; MD = –1.99; 95% CI: –3.04, –0.95, p < 0.001) , and abdominal premeter (AP; MD = –2.24; 95% CI: –3.49 to –1.00; P < 0.001), and increased the frequency of borborygmus per minute (FOB; MD = 0.85; 95% CI: 0.52 to 1.18; P < 0.001). No significant difference was found between this two groups in both mortility at day 28 (RR = -0.74; 95% CI: 0.49–1.11; P = 0.14) and the incidence of adverse events (OR = 1.01; 95% CI: 0.22–4.58; P = 0.99). Conclusions: This study indicated that in S-GID patients, on the basis of conventional treatment, combination with acupuncture could potentially reduce IAP, AP value and AGI grade, increase FOB values, lower APACHE-II score with good safety. However, the 28-day mortality data showed no significant difference, likely due to insufficient sample size. A multicenter, randomized, double-blind controlled study is required for further confirmation.