Rédacteur : Johan Nguyen

Sommaire

Sepsis

Sepsis/ Septicémie

1. Systematic Reviews and Meta-Analysis

☆☆☆ Evidence for effectiveness and a specific effect of acupuncture
☆☆ Evidence for effectiveness of acupuncture
☆ Limited evidence for effectiveness of acupuncture
Ø No evidence or insufficient evidence

1.1. Xian 2023

Xian J, Wang L, Zhang C, Wang J, Zhu Y, Yu H, Zhang X, Tan Q. Efficacy and safety of acupuncture as a complementary therapy for sepsis: a systematic review and meta-analysis. Acupunct Med. 2023 Feb;41(1):3-15. https://doi.org/10.1177/09645284221086288

Background Sepsis is a life-threatening organ dysfunction caused by dysregulation of the host response to infection. Acupuncture is used for treatment of inflammatory diseases; however, its effectiveness and safety as a complementary therapy for sepsis has not been fully explored.
MethodsData were retrieved from eight databases. Randomized controlled trials (RCTs) that compared acupuncture plus conventional therapies versus conventional therapies alone were included. Pre-specified primary outcomes were mortality at 28 days and Acute Physiologic and Chronic Health Evaluation (APACHE) II scores.
ResultsA total of 17 studies with 1099 participants were included in this study. In terms of the primary outcomes, acupuncture plus routine therapy reduced mortality at 28 days (risk ratio (RR)): 0.69, 95% confidence interval (CI): 0.52 to 0.91, p < 0.001) and APACHE II scores (mean difference (MD): -2.84, 95% CI: -4.09 to -1.58, p < 0.001) at day 7 after treatment compared with routine therapy alone. In terms of secondary outcomes, acupuncture plus routine therapy reduced white blood cell counts and levels of procalcitonin (PCT), tumor necrosis factor (TNF)-α, interleukin (IL)-6 and lactic acid and intra-abdominal pressure (IAP), and improved CD3+, CD4+ and monocytes of human leukocyte antigen (HLA)-DR at day 7 after treatment compared with routine therapy alone. However, acupuncture plus routine therapy had no significant effects on levels of IL-10, C-reactive protein (CRP), CD8+ and CD4+/CD8+ ratios compared with routine therapy alone. Quality of evidence was low to very low for all parameters (GRADE).
ConclusionThe available evidence showed that combination of acupuncture and routine therapy may have benefit for sepsis compared with use of routine therapy only. Due to the low degree of certainty regarding its effects, further research is required.

1.2. Tang 2020 ☆

Tang Yidan. [Efficacy and safety of acupuncture on sepsis: a systematic review]. Chinese Journal of Evidence-Based Medicine. 2020. [212949].

Objectives To systematic review the efficacy and safety of acupuncture on patients with sepsis.
Methods The PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data, VIP and CBM databases were searched. The retrieval time was from inception to October 1st, 2019. Randomized controlled trials（RCTs） on acupuncture on sepsis were screened. Two researchers independently screened articles, extracted and analyzed data, and evaluated risk of bias included in the study. Meta-analysis was performed by RevMan 5. 3 software.
Results A total of 20 RCTs involving 1 337 patients were included. Meta-analysis showed that there were significant differences between the acupuncture group with conventional treatment in 28-day mortality [RR=0. 69, 95%CI（0. 5, 0. 9）, P=0. 03], APACHEⅡ score at 3rd day [MD=-2. 4, 95%CI（-3. 68, -1. 12）, P=0. 0002] and 7thday [MD=-4. 37, 95%CI（-6. 32, -2. 21）, P<0. 0001], length of the ICU stay[MD=-1. 54, 95%CI（-2. 81, -0. 27）, P=0. 02], the effective rate for improved gastrointestinal function [RR=1. 5, 95%CI（1. 09, 2. 06）, P=0. 01], concentrations of PCT [MD=-2. 23, 95%CI（-3. 33, -1. 13）, P<0. 001] and TNF-α [MD=-14. 86, 95%CI（-23. 74, -5. 97）, P=0. 001] at the 7thday. However, there was no significant difference between two groups on the CD8+count at the 7thday [MD=1. 65, 95%CI（-0. 32, 3. 62）, P=0. 1].
Conclusions Available evidence suggests that acupuncture may be a potential treatment method for sepsis patients. Due to limited quantity and quality of included studios, the above conclusions are required to be verified by more high-quality studies.

1.3. Wang 2018

Wang Li-Juan, Li Jian, Li Xiao-Juan. [Efficacy and Safety of Acupuncture Therapy for Sepsis: A Meta-Analysis]. Guiding Journal of Traditional Chinese Medicine and Pharmacy. 2018;23:86-90. [201754].

ObjectiveTo systematically evaluate the clinical efficacy and safety of acupuncture therapy for sepsis.
MethodsThe electronic searches in databases of CNKI, CBM, WanFang, PubMed and handsearches the essays on important academic conferences, from the establishment time of databases to June 2017, to collect randomized controlled trials(RCTs) on acupuncture therapy for sepsis. Quality evaluation and date extraction were implemented by two researchers independently for the literature which met the inclusion and exclusion criteria, by the “risk of bias” assessment tool of Cochrane. The RevMan 5.3 software was used to make Mate-analysis.
Results Twelve RCTs including 811 cases of sepsis were included. According to the results of Meta-analysis, compared with the conventional treatment group(the control group), 28 day mortality [RR=0.48, 95%CI(0.25,0.92), P=0.03] in the combined acupuncture treatment group(the experimental group) were lower; The APACHE Ⅱ sore and the levels of PCT in the experimental group was lower than that in the control group; The improvement of gastrointestinal dysfunction in the clinical efficacy was higher; None of the studies reported any adverse reactions of acupuncture.
Conclusion Current evidence showed that acupuncture therapy can reduce systemic inflammatory response, promote functional recovery of the body, improve the clinical symptoms and prognosis in patients with sepsis; what’s more, it is safe. But it needs to be supported by the results of RCTs of multicenter and large samples.