Efficacy of melatonin as adjunctive therapy for sepsis: A meta-analysis of randomized controlled trials

IF 3.3 3区医学 Q1 INTEGRATIVE & COMPLEMENTARY MEDICINE

Complementary therapies in medicine Pub Date : 2025-02-21 DOI:10.1016/j.ctim.2025.103147

Zhuangzhuang Sun , Cheng Yu , Zhaopeng Zhang , Chunjie Hu , Xin Li , Xiheng Dong , Ru Zhang , Zhirun Zhang , Tonggang Zhu , Xin Su , Junpeng Guo

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引用次数: 0

Abstract

Background

This study systematically evaluates the therapeutic efficacy of melatonin as an adjunctive therapy, aiming to determine its potential to reduce mortality and mitigate inflammatory responses in patients with sepsis.

Methods

A search was conducted across PubMed, Web of Science, Cochrane Library, and Embase databases. The Cochrane Collaboration Risk of Bias (ROB) tool was systematically employed to assess the potential for bias in the relevant studies. The I² statistic was employed to evaluate heterogeneity among the studies. Potential publication bias was assessed using Begg's test. Sensitivity analysis was performed to examine the stability of the results. Additionally, a GRADE evaluation of the evidence level.

Results

This meta-analysis encompassed a total of seven randomized controlled trials involving 421 patients diagnosed with sepsis. The primary results indicated that the mortality rate in the intervention group was significantly lower than that in the control group, suggesting that melatonin may effectively reduce mortality among sepsis patients [OR = 0.42, 95 % CI: 0.23–0.77, P = 0.005]. Additionally, the CRP levels in the intervention group were markedly lower than those in the control group, providing evidence that melatonin possesses anti-inflammatory properties that may help decrease inflammatory markers in sepsis patients [SMD= -4.00, 95 % CI: −6.47 to −1.53, P = 0.001]. Furthermore, Secondary outcome results showed no statistically significant differences in sequential organ failure assessment (SOFA) scores, length of hospital stay, and adverse effects. A sensitivity analysis confirmed the robustness of the findings from the included studies. By applying the GRADE system to evaluate the quality of evidence, we found the evidence in four grades: one rated as high quality, one as medium quality, and three rated as low quality.

Conclusion

Melatonin, when used as an adjuvant therapy, significantly reduces mortality and lowers the levels of the inflammatory marker CRP in patients with sepsis, while also improving their physical condition. However, due to the limited number and quality of the articles, these conclusions warrant further verification through the conduct of additional high-quality research.

查看原文本刊更多论文

褪黑素作为脓毒症辅助治疗的疗效：随机对照试验的荟萃分析。

背景：本研究系统评估褪黑素作为辅助治疗的疗效，旨在确定其在脓毒症患者中降低死亡率和减轻炎症反应的潜力。方法：检索PubMed、Web of Science、Cochrane Library和Embase数据库。系统地使用Cochrane协作偏倚风险（ROB）工具评估相关研究的潜在偏倚。采用I²统计量评价各研究间的异质性。使用贝格检验评估潜在发表偏倚。进行敏感性分析以检验结果的稳定性。此外，对证据水平进行GRADE评价。结果：这项荟萃分析共纳入了7项随机对照试验，涉及421名败血症患者。初步结果显示干预组的死亡率明显低于对照组，提示褪黑素可有效降低脓毒症患者的死亡率[OR =0.42, 95% CI: 0.23 ~ 0.77， P=0.005]。此外，干预组CRP水平明显低于对照组，这表明褪黑素具有抗炎特性，可能有助于降低脓毒症患者的炎症标志物[SMD=-4.00, 95% CI: -6.47 ~ -1.53， P= 0.001]。此外，次要结局结果显示在顺序器官衰竭评估（SOFA）评分、住院时间和不良反应方面没有统计学上的显著差异。敏感性分析证实了纳入研究结果的稳健性。通过应用GRADE系统对证据质量进行评价，我们将证据分为4个等级：1个为高质量，1个为中等质量，3个为低质量。结论：褪黑素作为辅助治疗可显著降低脓毒症患者的死亡率，降低炎症标志物CRP水平，同时改善患者的身体状况。然而，由于文章的数量和质量有限，这些结论需要通过进行额外的高质量研究来进一步验证。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Complementary therapies in medicine 医学-全科医学与补充医学

CiteScore

8.60

自引率

2.80%

发文量

101

审稿时长

112 days

期刊介绍： Complementary Therapies in Medicine is an international, peer-reviewed journal that has considerable appeal to anyone who seeks objective and critical information on complementary therapies or who wishes to deepen their understanding of these approaches. It will be of particular interest to healthcare practitioners including family practitioners, complementary therapists, nurses, and physiotherapists; to academics including social scientists and CAM researchers; to healthcare managers; and to patients. Complementary Therapies in Medicine aims to publish valid, relevant and rigorous research and serious discussion articles with the main purpose of improving healthcare.