Abstract
ObjectivesA meta-analysis was conducted to investigate the effects of ulinastatin treatment on adult patients undergoing cardiac surgery under cardiopulmonary bypass (CPB).MethodsSeven electronic databases were searched for reports of randomized, controlled trials conducted up to February 2014 in which patients undergoing cardiac surgery with CPB were administered ulinastatin in the perioperative period.ResultsFifty-two studies with 2025 patients were retained for analysis. The results showed that the ulinastatin can attenuate the plasma levels of pro-inflammatory cytokines and enhance the anti-inflammatory cytokine levels in patients undergoing cardiac surgery with CPB. Meanwhile, the ulinastatin had a significant beneficial effect on myocardial injury. The mean differences (MD) and 95% confidence intervals (95% CI) of biochemical markers were −63.54 (−79.36, −47.72) for lactate dehydrogenase, −224.99 (−304.83, −145.14) for creatine kinase, −8.75 (−14.23, −3.28) for creatine kinase-MB, and −0.14 (−0.20, −0.09] for troponin I (all P<0.01). However, neither hemodynamics nor cardiac function improved significantly, except that the MD and 95% CI of mean arterial pressure were 2.50 (0.19, 4.80) (P = 0.03). There were no statistically significant differences in the use of inotropes, postoperative bleeding, postoperative complications, the intensive care unit (ICU) stay, and the hospital stay; however, the frequency of auto resuscitation increased significantly (OR 1.98, 95%CI 1.19 to 3.30, P<0.01), the duration of intubation (MD −1.58, 95%CI −2.84 to −0.32, P<0.01) and the duration of mechanical ventilation (MD −3.29, 95%CI −4.41 to −2.17, P<0.01) shortened significantly in patients who were treated with ulinastatin.ConclusionsUlinastatin can reduce the plasma levels of pro-inflammatory cytokines and elevate anti-inflammatory cytokine in patients from China and Japan undergoing cardiac surgery with CPB. Ulinastatin treatment may have protective effects on myocardial injury, and can increase the frequency of auto resuscitation, shorten the duration of intubation and mechanical ventilation.
Highlights
A systemic inflammatory response (SIR) and multiple-organ ischemia/reperfusion injury often occur after open-heart surgery carried out under cardiopulmonary bypass (CPB) [1]
The groups showed no significant differences with respect to gender [odds ratio (OR) were 0.85 (0.69, 1.04), P50.12], age [mean difference (MD) were -0.14 (20.58, 0.31), P50. 55], CPB time [MD were 20.95 (22.34, 0.44), P50.18], or aortic cross-clamping time [MD were 20.48 (21.52, 0.57), P50.37] (Table 2)
The results showed that the frequency of autoresuscitation increased significantly in the ulinastatin group, but there were no statistically significant differences in the number of patients needing inotropes (OR: 0.98, 95%confidence interval (CI) 0.52 to1.85, P50.96), the postoperative bleeding
Summary
A systemic inflammatory response (SIR) and multiple-organ ischemia/reperfusion injury often occur after open-heart surgery carried out under cardiopulmonary bypass (CPB) [1]. The activation of the complement cascade and fibrinolytic system by multiple physical, chemical, and biological stimuli in CPB, along with neutrophil activation and the generation of a sequential inflammatory cascade, contribute to a series of postoperative complications [2, 3], such as post-surgical bleeding, acute lung injury, acute respiratory distress syndrome, cardiac insufficiency, and acute renal injury [4, 5]. This results in prolongation of mechanical ventilation and ICU or hospital stay, and increases costs. Since the effect of ulinastatin on patients’ responses to CPB and the associated potential challenges and complications are not yet clear, we conducted a systematic review and meta-analysis to assess studies that used ulinastatin in order to evaluate its effect in patients undergoing openheart surgery with CPB
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