The Effects of Melatonin and Propolis on Markers of Inflammation, Oxidative Stress, Clinical Outcomes, and Survival Rate in Patients with Primary Sepsis Hospitalized in Intensive Care Unit: A Randomized Clinical Trial

Abstract Background: Systemic Inflammatory Response Syndrome (SIRS) that occurs under stressful conditions affecting all organs of the body. Previous studies have shown that propolis and melatonin have the potential to improve inflammation and oxidative stress, so the aim of this study was to investigate the effects of these supplements on SIRS treatment.Method: This was a randomized, controlled clinical trial in SIRS patients comprising 55 subjects that were randomly assigned to 3 intervention or control groups. In the 3 intervention groups, patients were treated with propolis alone (at dose of 1000 mg/day), propolis (1000 mg/day) plus melatonin (20 mg/day), and melatonin alone (20 mg/day) respectively, while there was no intervention in the control group. The inflammatory and oxidative stress markers and clinical outcomes were measured before and after of the intervention, also 28-day survival rate was assessed. Results: Propolis plus melatonin reduced serum interleukin 6 (p = 0.001) and CRP levels (p <0.001), and was associated with an increased gavage intake (p = 0.016). At the end of the study, there was no difference between the groups in the oxidative stress and hematological indices. In the propolis+melatonin group, the clinical outcomes were significantly improved (p <0.05). Also the SOFA score between the groups did not differ at any time, its changes was significant during the time (p>0.001). The average survival after 28 days of follow-up in the propolis, propolis+melatonin, melatonin and control groups were 24.08, 25.69, 22.05 and 19.42 days respectively, although this was not statistically significant (p=0.07).Conclusion and relevance: Supplementation with propolis+melatonin may help to improve clinical outcomes by reducing inflammation and was probably associated with an increase in the calorie intake, leading to an increase in the survival rate in SIRS patients, although more studies are necessary to prove these effects. Trial registration: IRCT20181025041460N1.