Clinical effect of combined ulinastatin and continuous renal replacement therapy on management of severe sepsis with acute kidney injury

Qiying Fang,Xinghua Zhao

doi:10.4314/tjpr.v16i4.26

Abstract

Purpose: To explore the effect of a combination of ulinastatin and continuous renal replacement therapy (CRRT) for the treatment of severe sepsis with acute kidney injury (SAKI).Methods: Clinical data for 106 patients diagnosed with SAKI from April 2013 to May 2015 in the intensive care unit (ICU) of Affiliated Hospital of Zhengzhou University, Zhengzhou, China, were collected and randomly assigned into two groups: treatment and control groups. The general information on the two groups were comparable. All the patients received a comprehensive treatment program which included fluid resuscitation, antibiotics, nutritional support and CRRT. The patients in treatment group also received intravenous injection of 300 thousand units/10 mL ulinastatin thrice daily for 5 days. Serum levels of inflammatory cytokines, oxidative stress level, kidney and blood coagulation functions were assayed before and after treatment, using standard methodologies. In addition, adverse reactions and 28-day mortality were recorded.Results: Levels of interleukin-6 (IL-6), tumor necrosis factor α (TNFα), serum C-reactive protein (CRP), procalcitonin (PCT), malondialdehyde (MDA), cystatin, blood urea nitrogen (BUN), prothrombin time (PT), activated partial thromboplastin time (APTT), serum creatinine (SCr) and urinary kidney injury molecule-1 (Kim-1) in the treatment group were significantly lower than those in the control group after ulinastatin treatment (p < 0.05). However, superoxide dismutase (SOD), fibrinogen (Fib) and total antioxidant capacity (T-AOC) in the treatment group were significantly higher in the control group after treatment (p < 0.05). No serious adverse drug reactions were seen in the two groups. In addition, there were no significant differences in 28-day mortality between the two groups.Conclusion: These results suggest that ulinastatin combined with CRRT effectively decreases serum levels of inflammation in SAKI patients through a mechanism involving improvement of antioxidant capacity, reduction of oxidative stress, and enhancement of renal and coagulation functions.Keywords: Ulinastatin, Continuous renal replacement therapy, Sepsis, Acute kidney injury, Inflammatory cytokines

Highlights

Sepsis is a common complication of wounds, burns, infection and other severe conditions in clinics
Four patients in treatment group withdrew from the study within 7 days due to transfers and other factors, while 6 individuals withdrew from control group
There were no significant differences in levels of serum CysC, blood urea nitrogen (BUN), serum creatinine (SCr) and urinary kidney injury molecule-1 (Kim-1) between patients in the two groups

Summary

Introduction

Sepsis is a common complication of wounds, burns, infection and other severe conditions in clinics. Studies show that there are about 18 million cases of new sepsis patients each year, accounting for 0.3 % of the total population, and growing at a rate of 1.5 % per year [1,2,3,4]. The treatment program for sepsis is regularly optimized, there is always high mortality rate in these patients. Acute kidney injury (AKI) is one of the common complications of sepsis. About 40% of sepsis eventually develops into sepsis-mediated acute kidney injury (SAKI). Mortality from SAKI is up to 70 %, which is about twice the population of sepsis patients without AKI [5,6]

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Results

Conclusion