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Effect of urinary protease inhibitor (ulinastatin) on cardiopulmonary bypass: a meta-analysis for China and Japan.

Zhang Y, Zeng Z, Cao Y, Du X, Wan Z - PLoS ONE (2014)

Bottom Line: Meanwhile, the ulinastatin had a significant beneficial effect on myocardial injury.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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China.

ABSTRACT

Objectives: A meta-analysis was conducted to investigate the effects of ulinastatin treatment on adult patients undergoing cardiac surgery under cardiopulmonary bypass (CPB).

Methods: Seven 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.

Results: Fifty-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.

Conclusions: Ulinastatin 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.

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Forest plot of complications in patients who received ulinastatin versus controls in open-heart surgery with CPB.OR, Odds Ratio; M-H, Mantel-Haenszel; MD, mean difference; CI, confidence interval.
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pone-0113973-g003: Forest plot of complications in patients who received ulinastatin versus controls in open-heart surgery with CPB.OR, Odds Ratio; M-H, Mantel-Haenszel; MD, mean difference; CI, confidence interval.

Mentions: These important clinical outcomes have aroused the concern of clinicians. The results showed that the frequency of autoresuscitation increased significantly (OR 1.98, 95%CI 1.19 to 3.30, P<0.01) in the ulinastatin group, but there were no statistically significant differences in the number of patients needing inotropes (OR: 0.98, 95%CI 0.52 to1.85, P = 0.96), the postoperative bleeding (MD 14.98, 95%CI −69.10 to 99.07, P = 0.73), or the postoperative complications (MD 0.68, 95%CI 0.44 to 1.04, P = 0.07) (Table 2). Postoperative complications, including the number of cases with myocardial injury, wound infection, reoperation for bleeding, liver dysfunction, renal dysfunction, respiratory dysfunction, and neurological problems, as well as the in-hospital mortality, are shown in detail in Fig. 3. Heterogeneity was seen only in the postoperative bleeding (P = 0.03, I2 = 61%), where a random-effect model was adopted. Sensitivity analysis showed that the overall effect was not changed by omitting one study (MD 56.79, 95%CI −2.09 to 115.67, P = 0.06) (Table 3).


Effect of urinary protease inhibitor (ulinastatin) on cardiopulmonary bypass: a meta-analysis for China and Japan.

Zhang Y, Zeng Z, Cao Y, Du X, Wan Z - PLoS ONE (2014)

Forest plot of complications in patients who received ulinastatin versus controls in open-heart surgery with CPB.OR, Odds Ratio; M-H, Mantel-Haenszel; MD, mean difference; CI, confidence interval.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4263539&req=5

pone-0113973-g003: Forest plot of complications in patients who received ulinastatin versus controls in open-heart surgery with CPB.OR, Odds Ratio; M-H, Mantel-Haenszel; MD, mean difference; CI, confidence interval.
Mentions: These important clinical outcomes have aroused the concern of clinicians. The results showed that the frequency of autoresuscitation increased significantly (OR 1.98, 95%CI 1.19 to 3.30, P<0.01) in the ulinastatin group, but there were no statistically significant differences in the number of patients needing inotropes (OR: 0.98, 95%CI 0.52 to1.85, P = 0.96), the postoperative bleeding (MD 14.98, 95%CI −69.10 to 99.07, P = 0.73), or the postoperative complications (MD 0.68, 95%CI 0.44 to 1.04, P = 0.07) (Table 2). Postoperative complications, including the number of cases with myocardial injury, wound infection, reoperation for bleeding, liver dysfunction, renal dysfunction, respiratory dysfunction, and neurological problems, as well as the in-hospital mortality, are shown in detail in Fig. 3. Heterogeneity was seen only in the postoperative bleeding (P = 0.03, I2 = 61%), where a random-effect model was adopted. Sensitivity analysis showed that the overall effect was not changed by omitting one study (MD 56.79, 95%CI −2.09 to 115.67, P = 0.06) (Table 3).

Bottom Line: Meanwhile, the ulinastatin had a significant beneficial effect on myocardial injury.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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China.

ABSTRACT

Objectives: A meta-analysis was conducted to investigate the effects of ulinastatin treatment on adult patients undergoing cardiac surgery under cardiopulmonary bypass (CPB).

Methods: Seven 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.

Results: Fifty-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.

Conclusions: Ulinastatin 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.

Show MeSH
Related in: MedlinePlus