Abstract
BackgroundUlinastatin has been prescribed to treat sepsis. However, there is doubt regarding the extent of any improvement in outcomes to guide future decision making.ObjectivesTo evaluate the effects of ulinastatin on mortality and related outcomes in sepsis patients.MethodsThirteen randomized controlled trials and two prospective studies published before September 1, 2018, that included 1358 patients with sepsis, severe sepsis, or septic shock were evaluated. The electronic databases searched in this study were PubMed, Medline, Embase, and China National Knowledge Infrastructure (CNKI) for Chinese Technical Periodicals.ResultsUlinastatin significantly decreased the all-cause mortality {odds ratio (OR) = 0.48, 95% confidence interval (CI) [0.35, 0.66], p < 0.00001, I2 = 13%}, Acute Physiology, Age, Chronic Health Evaluation II (APACHE II) score {mean difference (MD) = -3.18, 95%CI [-4.01, -2.35], p < 0.00001, I2 = 33%, and reduced the incidence of multiple organ dysfunction syndrome (MODS) (OR = 0.3, 95% CI [0.18, 0.49], p < 0.00001, I2 = 0%). Ulinastatin also decreased the serum levels of IL-6 (MD = -53.00, 95% CI [-95.56, -10.05], p = 0.02), TNF-a MD = -53.05, 95%CI [-68.36, -37.73], p < 0.00001, and increased the serum levels of IL-10 (MD = 37.73, 95% CI [16.92, 58.54], p = 0.0004). Ulinastatin administration did not lead to any difference in the occurrence of adverse events.ConclusionsUlinastatin improved all-cause mortality and other related outcomes in patients with sepsis or septic shock. The results of this meta-analysis suggest that ulinastatin may be an effective treatment for sepsis and septic shock.
Highlights
Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection (Singer et al, 2016)
All-Cause Mortality We extracted the data from 12 studies (Fang and Chen, 2005; Shao et al, 2005; Ni et al, 2008; Sung et al, 2009; Tang, 2013; Wu et al, 2013b; Karnad et al, 2014; Chen et al, 2015; Choudhuri et al, 2015; Wu et al, 2016; Fang and Zhao, 2017; Pavan Kumar Rao et al, 2017) and 1110 participants were classified into two groups to assess all-cause mortality
All-cause mortality was significantly lower in the UTI group than in the control group (OR = 0.48, 95% confidence intervals (CIs) [0.35, 0.66], p < 0.00001), and heterogeneity was low (x2 = 12.57, p = 0.32, I2 = 13%)
Summary
Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection (Singer et al, 2016). It is the major cause of death in intensive care units (Martin et al, 2003). Sepsis initiates a complex interplay of host pro-inflammatory and anti-inflammatory processes (Hotchkiss et al, 2013; Chousterman et al, 2017). Both inflammatory response and immunosuppression are involved in sepsis (Hotchkiss et al, 2013; Hotchkiss and Crouser, 2015). There is doubt regarding the extent of any improvement in outcomes to guide future decision making
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