Use of acupuncture in sepsis with gastrointestinal dysfunction: A systematic review and meta-analysis

Background: Acupuncture (AP) is widely used in hospitalized patients. However, high-quality evidence supporting its use in patients with sepsis-induced gastrointestinal dysfunction remains limited. Objective: This study aims to conduct a systematic review and meta-analysis to evaluate the effects of AP in patients with sepsis-induced gastrointestinal dysfunction. Methods: PubMed, Embase, Web of Science, SinoMed, VIP Database, Wanfang Data Knowledge Service Platform, China National Knowledge Infrastructure, and the Cochrane Library were searched from inception to March 10, 2024. We included randomized controlled trials (RCTs) that focused on adult patients with sepsis receiving AP and compared them with a control group. The primary outcome was gastrointestinal indicators. Sensitivity analysis, subgroup analysis, and assessment of publication bias were conducted to explore the potential heterogeneity among the included studies. Results: A total of 23 RCTs involving 1603 patients were included. Overall, AP significantly improved gastrointestinal indicators, including intra-abdominal pressure (mean difference [MD] = −1.97 cm H 2 O; 95% confidence interval [CI]: −2.77, −1.16; P < 0.00001), bowel sounds (MD = 0.91 per minute; 95% CI: 0.66, 1.16; P < 0.00001), and gastric residual volume (MD = −46.94 mL; 95% CI: −83.45, −10.43; P = 0.01). These findings were corroborated by subgroup and sensitivity analyses. AP also showed significant benefits in inflammation indicators (procalcitonin, tumor necrosis factor- α , and interleukin-6), gastrointestinal function indicators ( D -lactate, diamine oxidase, intestinal fatty acid–binding protein, and motilin), disease severity scores (Acute Physiology and Chronic Health Evaluation II score and gastrointestinal dysfunction score), clinical prognosis, and other critical clinical outcomes (total effective rate and time to achieve target enteral nutrition) (all P values < 0.05). Additionally, the mortality rate in the AP group was comparable to that of the control group. Conclusion: Our findings suggest that AP significantly improves gastrointestinal indicators and other clinical outcomes in patients with sepsis and gastrointestinal dysfunction, indicating its potential as a promising therapeutic option. However, due to the small sample sizes and substantial heterogeneity among the included studies, further high-quality, multicenter RCTs are needed to validate these results.