The Effects of Bromelain Supplementation on Clinical Outcomes, Inflammatory and Oxidative Stress Biomarkers in Patients With Traumatic Brain Injury: A Randomized, Double-Blind Placebo-Controlled Clinical Trial.

Traumatic brain injury (TBI) is the leading cause of death from injury. Many studies have shown that cytokines, chemokines, and oxidative stress play a crucial role in the pathophysiology of TBI. One of the types of interventions that are receiving more and more attention is nutritional support and the use of nutritional supplements to reduce inflammation in these patients. The present study was a double-blind controlled clinical trial, performed on patients with traumatic brain injury. Patients in the intervention group received 600 mg of oral bromelain daily through gavage, while the patients in the control group received a placebo for 14 days. SOFA, APACHE, and NUTRIC scores were evaluated at each time of blood sampling and 28- and 60-day mortality. Also, clinical and biochemical information (CRP, MDA, IL-6, and TAC), anthropometry, and nutritional information of patients were recorded during the study. There was no significant difference between the two groups in terms of gender, weight, BMI, MAC, APACHE SCORE, NUTRIC SCORE, SOFA SCORE, and energy intake at the beginning of the study (p > 0.05). Bromelain supplementation significantly reduced IL-6 levels (p < 0.001), APACHE score (p = 0.011), SOFA score (p < 0.001), and NUTRIC score (p < 0.001). Furthermore, 60-day mortality was significantly lower in the bromelain group compared to the placebo group (p = 0.036). However, there was no significant effect on CRP (p = 0.377), MDA (p = 0.061), TAC levels (p = 0.185). Bromelain supplementation significantly improved IL-6 levels, APACHE, SOFA, and NUTRIC scores, and reduced 60-day mortality in patients with traumatic brain injury. However, its effects on CRP, MDA and TAC levels were not statistically significant. These findings suggest that bromelain may serve as a promising adjunctive therapy to reduce inflammation and improve clinical outcomes in critically ill TBI patients. Further studies with larger sample sizes and longer follow-up periods are needed to confirm these results.