Abstract
Background: Sepsis has high mortality and is responsible for significant healthcare costs. Chinese herbal injections (CHIs) have been widely used in China as a novel and promising treatment option for sepsis. Therefore, this study assessed and ranked the effectiveness of CHIs to provide more sights for the selection of sepsis treatment. Method: Eight databases were searched from their inception up to September 1, 2021. The methodological quality of included study was evaluated by the Revised Cochrane risk-of-bias tool for randomized trials. Then Bayesian network meta-analysis was performed by OpenBUGS 3.2.3 and STATA 14.0 software. The surface under the cumulative ranking curve (SUCRA) probability values were applied to rank the examined treatments. Publication bias was reflected by a funnel plot. Results: A total of 50 eligible randomized controlled trials involving 3,394 participants were identified for this analysis. Five CHIs including Shenfu injection, Shenmai injection, Shengmai injection, Shenqifuzheng injection, and Huangqi injection were included. The results of the NMA and sensitivity analysis showed that Shenqifuzheng (MD = −4.48, 95% CI = −5.59 to −3.24), Shenmai (MD = −3.38, 95% CI = −4.38 to −2.39), Shenfu (MD = −2.38, 95% CI = −3.03 to −1.70) and Shengmai (MD = −1.90, 95% CI = −3.47 to −0.31) combined with Western medicine (WM) had a superior effect in improving the APACHE II score. Based on SUCRA values, Shenqifuzheng injection (95.65%) ranked highest in the APACHE II score, followed by Shenmai (74%), Shenfu (47.1%), Shengmai (35.3%) and Huangqi injection (33.2%). Among the secondary outcomes, Shenmai injection was the most favorable intervention in reducing PCT and CRP levels, and Shenqifuzheng injection was the second favorable intervention in reducing CRP level. Shenfu injection combined with WM was more effective than the other treatments in decreasing the serum IL-6 and TNF-α levels and lowering the 28-days mortality. Regarding the improvement of immune function, Shenqifuzheng injections had obvious advantages. Conclusion: In conclusion, Shenqifuzheng injection was the optimum treatment regimen to improve APACHE II score, reduce CRP level, and regulate immune function. Shenfu injection was superior in reducing the expression of inflammatory factors and decreasing 28-days mortality. Nevertheless, more multicenter, diverse, and direct comparisons randomized controlled trials are needed to further confirm the results. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=254531, identifier CRD42021254531.
Highlights
Sepsis is life-threatening organ dysfunction caused by dysregulated host response to infection (Singer et al, 2016)
50 studies that met the inclusion criteria were included in our Bayesian network meta-analysis (NMA). 347 records were excluded for the following reasons: 1) incorrect randomized method or observational studies (n = 62); 2) the use of irrelevant drugs (n = 13); 3) incorrect data or repeated data (n = 16); 4) no interested outcomes (n = 89); 5) duration of therapy or the time of outcomes measurements were not satisfied (n = 98); 6) no original papers (n = 15); (7) others (n = 54)
Shenfu combined Western medicine (WM) was more effective than WM alone (OR = 0.55, 95% credible intervals (CIs) = 0.37 to 0.78), while the results showed no significant difference in the remaining cases according to Table 3
Summary
Sepsis is life-threatening organ dysfunction caused by dysregulated host response to infection (Singer et al, 2016). Therapies for sepsis and septic shock mainly depend on fluid resuscitation, antibiotics, vasoactive agents, corticosteroid, and mechanical ventilation (Evans et al, 2021). The mainstays of treatments are early antibiotics and restoration of perfusion (IV fluids and vasopressor therapy), which are crucial for the prognosis of patients with sepsis or septic shock (Seymour et al, 2017; Kuttab et al, 2019). Initiation of broad-spectrum antibiotic therapy is strongly recommended in patients with sepsis and septic shock as it is associated with improved outcomes (Zhang D. et al, 2015; Seymour et al, 2017). The problem of antimicrobial resistance (AMR) has increased significantly worldwide (Marston et al, 2016), and decreasing the use of broad-spectrum antibiotics is a priority as this is obviously connected with the problem of AMR This appears to be closely relevant in the ICU(De Waele et al, 2018). This study assessed and ranked the effectiveness of CHIs to provide more sights for the selection of sepsis treatment
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