L-carnitine supplementation to prevent postoperative complications after cardiac surgery: A systematic review and meta-analysis of randomised clinical trials.

IF 2.9 Q1 ANESTHESIOLOGY

Indian Journal of Anaesthesia Pub Date : 2025-06-01 Epub Date: 2025-05-14 DOI:10.4103/ija.ija_1325_24

Laila Shalabi, Ahmed Ibrahim, Mohamed Adel Elsawy, Sofian Zreigh, Muhiddin Dervis, Mohamed N Elshabrawi, Sohaila Mourad, Mohamed A Arafa, Mohamed Abuelazm

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Abstract

Background and aims: Cardiac surgeries often lead to postoperative complications, which affect recovery and increase morbidity and mortality. This systematic review aims to assess L-carnitine's effect on preventing postoperative complications across various cardiac surgeries, addressing gaps in current literature on its potential therapeutic benefits.

Methods: We systematically searched Web of Science, Cochrane, Embase, PubMed, and Scopus databases until March 2025. Statistical analysis was performed using R version 4.3.2. Effect sizes were measured with relative risks (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, while heterogeneity was evaluated using the I² statistic.

Results: Thirteen randomised controlled trials(RCTs) with 786 patients were included. L-carnitine significantly increased the cardiac index (CI) (MD: 0.14; 95% CI: 0.07, 0.20; P < 0.01) and left ventricular stroke work index (LVSWI) (MD: 0.42; 95% CI: 0.06, 0.78; P = 0.02). In addition, L-carnitine significantly improved the left ventricular ejection fraction (LVEF) (MD: 7.88; 95% CI: 6.67, 9.09; P < 0.01), with a significant reduction in postoperative atrial fibrillation (POAF) (RR: 0.53; 95% CI: 0.30, 0.95; P = 0.03). In contrast, there was no significant reduction in in-hospital mortality (RR: 0.51; 95% CI: 0.10, 2.63; P = 1.00) and stroke incidence (RR: 0.85; 95% CI: 0.12, 5.76; P = 0.82).

Conclusion: Preoperative administration of L-carnitine demonstrates meaningful short-term benefits in enhancing CI, LVSWI, and LVEF while reducing the incidence of POAF following cardiac surgery. These findings suggest a potential role for L-carnitine supplementation in optimising perioperative cardiac care, enhancing recovery, and reducing complications following cardiac surgery. However, the existing studies are limited in scope, making it challenging to draw robust conclusions.

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补充左旋肉碱预防心脏手术后并发症：随机临床试验的系统回顾和荟萃分析

背景与目的：心脏手术常导致术后并发症，影响康复，增加发病率和死亡率。本系统综述旨在评估左旋肉碱在各种心脏手术中预防术后并发症的作用，解决目前文献中关于其潜在治疗益处的空白。方法：系统检索Web of Science、Cochrane、Embase、PubMed、Scopus等数据库，检索截止至2025年3月。采用R 4.3.2版本进行统计分析。用相对危险度（RR）测量二分结局的效应量，用平均差异（MD）测量连续结局的效应量，用I²统计量评估异质性。结果：纳入13项随机对照试验（RCTs）， 786例患者。左旋肉碱显著提高心脏指数（CI） (MD: 0.14；95% ci: 0.07, 0.20；P < 0.01)和左室卒中工作指数（LVSWI） (MD: 0.42；95% ci: 0.06, 0.78；P = 0.02)。此外，左旋肉碱显著改善左心室射血分数（LVEF） (MD: 7.88；95% ci: 6.67, 9.09；P < 0.01)，术后房颤（POAF）发生率显著降低(RR: 0.53；95% ci: 0.30, 0.95；P = 0.03)。相比之下，住院死亡率没有显著降低(RR: 0.51；95% ci: 0.10, 2.63；P = 1.00)和卒中发生率(RR: 0.85；95% ci: 0.12, 5.76；P = 0.82)。结论：术前给予左旋肉碱在提高CI、LVSWI和LVEF以及降低心脏手术后POAF发生率方面具有显著的短期益处。这些发现提示补充左旋肉碱在优化围手术期心脏护理、促进康复和减少心脏手术并发症方面的潜在作用。然而，现有的研究范围有限，很难得出可靠的结论。

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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