Abstract
Purpose A specific and efficacious method for treatment of pneumonia-derived sepsis is lacking. Chengqi decoction has been used for treatment of pneumonia-derived sepsis, but a clinical trial on patients with pneumonia-derived sepsis is lacking, a gap in the literature that we sought to fill. Patients and Methods. 282 patients with pneumonia-derived sepsis admitted to the intensive care unit of our hospital were selected. They were divided into the treatment group (141 cases) and control group (141 cases). Both groups underwent conventional treatment, but Chengqi decoction (in the form of enema) was given to the treatment group. Mortality, morbidity (abdominal distension and gastrointestinal bleeding), duration of antibiotic use, and use of vasoactive agents were documented 28 days after the drug was used. Results The treatment group reduced mortality and morbidity (abdominal distension) (P < 0.05). After adjustment for significant covariates, 28-day survival was similar for the whole group (hazard ratio (HR): 0.48; 95% confidence interval (CI): 0.23–0.97; P=0.037), for the subgroup (n = 120) with Acute Physiology and Chronic Health Evaluation II score ≥25 (HR: 0.180; 95% CI: 0.032–0.332; P=0.039) and for the subgroup (n = 66) with N-terminal B-type natriuretic peptide <1800 (0.059, 0.004–0.979, and 0.019). There was no difference between the two groups for the duration of antibiotic use, major bleeding, or use of vasoactive drugs. Conclusions Chengqi decoction improved 28-day survival and reduced the prevalence of abdominal distension in patients with pneumonia-derived sepsis.
Highlights
Sepsis is a clinical syndrome involving physiological, biological, and biochemical abnormalities and life-threatening organ dysfunction caused by a dysregulated inflammatory response to infection
We wished to ascertain if CD can be used to reduce the risk of death from pneumonia-derived sepsis (PDS), abdominal distension, gastrointestinal bleeding, use of vasoactive drugs, and duration of antibiotic use
The characteristics documented at baseline were age, sex, weight, height, body mass index (BMI), diagnosis upon hospital admission, Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, central venous pressure, white blood cell count, neutrophilic granulocyte percentage, pH, arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), PaO2/fraction of inspired oxygen (FiO2), central venous oxygen saturation (ScvO2), as well as levels of lactate, N-terminal B-type natriuretic peptide (NT-proBNP), creatinine, blood urea nitrogen (BUN), C-reactive protein, and procalcitonin
Summary
Sepsis is a clinical syndrome involving physiological, biological, and biochemical abnormalities and life-threatening organ dysfunction caused by a dysregulated inflammatory response to infection. Severe pneumonia is caused by infection by pathogenic microorganisms and is the main infection site of sepsis [4]. Patients suffering from severe sepsis often develop intestinal injury, which hampers treatment [5]. Enemas containing TCM formulations have important roles in the immunomodulation of sepsis [8]. CD has an anti-inflammatory role in sepsis and prevents translocation of intestinal flora. A large volume of toxins accumulates in the intestinal tract, so using enemas containing TCM formulations could become a new method of sepsis treatment [10]. We wished to ascertain if CD can be used to reduce the risk of death from pneumonia-derived sepsis (PDS), abdominal distension, gastrointestinal bleeding, use of vasoactive drugs, and duration of antibiotic use. We sought to identify the characteristics of CD that could reduce the risk of death from PDS by 28 days by relieving gastrointestinal complications
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