Effects of ulinastatin on cerebral oxygen metabolism and CRP levels in patients with severe traumatic brain injury

The protective effect of ulinastatin combined with Xuebijing on myocardial injuries in patients with severe pneumonia

OBJECTIVE

To explore the protective effect of ulinastatin combined with Xuebijing on myocardial injuries in patients with severe pneumonia.

METHODS

The clinical data of 86 patients with severe pneumonia treated in our hospital were analyzed retrospectively. According to the treatment method each patient was administered, they were divided into a control group (43 cases, routine treatment + Xuebijing) and an observation group (43 cases, routine treatment + Xuebijing + ulinastatin). All the patients were treated for 2 weeks. The clinical efficacy, the inflammatory factor levels (TNF-α, C-reactive protein (CRP), and procalcitonin (PCT)), the myocardial index levels (creatine kinase-myocardial band (CK-MB), lactic dehydrogenase (LDH), α-hydroxybutyrate dehydrogenase (α-HBDE), N-terminal pro-brain natriuretic peptide (NT-proBNP), and cardiac troponin I (cTn I)), the blood gas index levels (arterial partial pressure of oxygen (PaO₂), oxygen saturation (SaO₂), and oxygenation index (OI)), the coagulation functions (prothrombin time (PT), activated partial thromboplastin time (APTT), and fibrinogen (FIB)) and the acute physiology and chronic health evaluation (APACHE-II) scores were compared between the two groups.

RESULTS

After the treatment, the total effective rate in the observation group was higher than it was in the control group (P<0.05). After the treatment, the serum TNF-α, CRP, PCT, CK-MB, LDH, α-HBDE, NT-proBNP, and cTnI levels and the APACHE-II scores were decreased in the two groups, and they were even lower in the observation group (all P<0.05). The PaO₂, SaO₂, and OI levels were increased in the two groups, and they were higher in the observation group (all P<0.05). Compared with before the treatment, the patients' PT and APTT levels in both groups were prolonged after the treatment, and the observation group was longer than the control group. The plasma FIB levels were decreased in both groups, and they were lower in the observation group than in the control group (P<0.05).

CONCLUSION

Ulinastatin combined with Xuebijing can significantly alleviate pulmonary inflammation, improve the blood gas, and protect the damaged myocardia in patients with severe pneumonia.

CRP Albumin ratio is positively associated with poor outcome in patients with traumatic brain injury

OBJECTIVES

The C-reactive protein/albumin ratio (CAR), a novel inflammation-based index, has been proved useful in predicting outcome of various diseases. We designed this study to explore the prognostic value of CAR in patients with traumatic brain injury (TBI).

PATIENTS AND METHODS

We retrospectively included 151 patients diagnosed with TBI and collected related clinical and laboratory data. Univariate and multivariate logistic regression were conducted to find independent risk factors of mortality. Then, we incorporated CAR into prognostic model and drew receiver operating characteristic (ROC) curve of models. Finally, we compared the predictive value of different models by evaluating the area under the receiver operating characteristic curves (AUC).

RESULTS

In this study, a total of 54 patients had poor survival outcome with mortality rate of 35.8 %. Results of multivariate analysis showed that GCS score in admission (OR 0.700, 95 %Cl 0.570-0.860, p=0.001), acute kidney injury (AKI) (OR 3.952, 95Cl 1.631-9.577, p=0.002) and CAR (OR 1.202, 95Cl 1.039-1.390, p=0.013) were independently associated with in-hospital mortality. The AUC value of predictive model composed of the above three factors was higher than GCS or CAR alone.

CONCLUSION

CAR is an independent risk factor of mortality in patients with TBI. Incorporating CAR into predictive model could increase the value in predicting outcome of TBI patients.

Reparative effects of lycium barbarum polysaccharide on mouse ovarian injuries induced by repeated superovulation

To explore the repair effect of lycium barbarum polysaccharide (LBP) on ovarian injuries induced by repeated superovulation in mice, a model of ovarian injury was established, and ovarian repair was assessed after intragastric administration of LBP. The oocyte quality and blastocyst rates of pronuclear embryos in vitro were observed. The levels of 8-hydroxydeoxyguanosine (8-OHdG) and lipid peroxide (LPO) in ovarian tissue were measured, and ovarian damage was assessed in paraffin sections. The groups with significant injury were selected according to the above observation, mice in the significant injury group were intragastrically administered with LBP (low dose, 25 mg/kg; medium dose, 35 mg/kg; and high dose, 45 mg/kg) for 30 days. The above measurements and anti-Müllerian hormone (AMH) expression were detected in the mouse ovaries and the breeding verification was carried out. Our results showed that repeated superovulation could cause mouse oocyte quality to drop, significant differences started from 4 superovulation events (P < 0.05). The levels of 8-OHdG and LPO in the ovary increased gradually as the number of superovulation events increased, and significant differences were observed after 4-6 superovulations (P < 0.05). The ratios of primordial follicles, primary, tertiary and mature follicles decreased and the ratio of atresia follicles increased as the number of superovulation events increased, especially in 4-6 superovulation groups. Thus, the groups of superovulation 4-6 events were considered as significant injury groups. LBP-medium dose groups significantly improved the number and quantity of oocytes and embryo blastocyst rate (P < 0.05), significantly decreased 8-OHdG and LPO levels in mice ovary (P < 0.05), also improved the ratios of all stages follicles and reduced the rate of atresia follicles, increased the numbers of litter size, live birth, weaning survival, and repaired the expression of AMH in ovary significantly (P < 0.05). In conclusion, the degree of ovarian injury was affected by the number of superovulation. LBP repaired ovarian injuries most likely through scavenging oxidative products 8-OHdG and LPO and increasing AMH protein expression.

Improvement of Sepsis Prognosis by Ulinastatin: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background: Ulinastatin has been prescribed to treat sepsis. However, there is doubt regarding the extent of any improvement in outcomes to guide future decision making. Objectives: To evaluate the effects of ulinastatin on mortality and related outcomes in sepsis patients. Methods: Thirteen 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. Results: Ulinastatin 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) = -2.40, 95% CI [-4.37, -0.44], p = 0.02, I² = 66%}, 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 = -88.5, 95% CI [-123.97, -53.04], p < 0.00001), TNF-α (MD = -56.22, 95% CI [-72.11, -40.33], 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. Conclusions: Ulinastatin 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.

The Efficacy and Immunomodulatory Effects of Ulinastatin and Thymosin α1 for Sepsis: A Systematic Review and Meta-Analysis

Objective. To systematically review the efficacy and potential immunomodulatory effect of ulinastatin combined with thymosin α1 (UTI) for sepsis. Design. A systematic review and meta-analysis of randomized controlled trials (RCTs). Data Sources. The following databases: PubMed, Embase, and Cochrane Central were searched to identify related clinical trials. The search terms were "ulinastatin", "thymosin", and "sepsis". Results. Six RCTs, 944 septic patients in total, were included in this meta-analysis. The result shows UTI increased the 28-day survival rate of septic patients, odds ratio (OR) = 2.01, 95% CI [1.53, 2.64]. After the treatment with UTI, the APACHE II score (four studies) dropped 4.72 further, mean = -4.72, 95% CI [-6.54, -2.91] (p < 0.00001). The mean time of ICU stay (four studies) in UTI group decreased 3.03 days further, mean = -3.03 [-6.99, 0.95] (p = 0.14), and mechanical ventilation time (four studies) decreased 2.05 days, mean = -1.81 [-2.96, -0.66] (p = 0.002). With the treatment of UTI, CD4+T cells raised 5.13%, mean = 5.13, 95% CI [2.75, 7.50] (p < 0.0001); there was no significant change in CD8+T cells, mean = -0.74 [-2.93, 1.45] (p = 0.51). Conclusion. According to this meta-analysis, with the treatment of UTI, the short-term survival rate of septic patients was increased and the illness severity was alleviated. ICU stay and mechanical ventilation time were effectively shortened. The beneficial effect of UTI might be due to the potential immunomodulatory effects of these two drugs.