Protective effect of Xuebijing injection on myocardial injury in patients with sepsis: a randomized clinical trial

Zhang, Hongwei; Wei, Liyou; Zhao, Gang; Liu, Shuzheng; Zhang, Zhenyu; Zhang, Jing; Yang, Yajing

doi:10.1016/s0254-6272(17)30003-1

Cited by 9 publications

(6 citation statements)

References 8 publications

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“…No additional AE occurrence was identified in this study. Furthermore, no serious AEs were observed to be associated with XBJ, which was consistent with those of the previous reports . At least one reason may be responsible for the low rate of XBJ-associated SAEs in the patients with sepsis in the current trial.…”

Section: Discussionsupporting

confidence: 92%

“…Recent studies have indicated that there are anti-inflammatory, anticoagulation, and immunoregulatory effects of moderate XBJ in animal models of sepsis . Clinical evidence was provided by the limited studies that were focused on the improvement of organ dysfunction, but there has been a lack of conclusive effect on mortality thus far. In patients with sepsis, independent meta-analysis found significant association with XBJ use; however, the small sample sizes and limited methodological quality may have affected the robustness and credibility of these findings .…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, no serious AEs were observed to be associated with XBJ, which was consistent with those of the previous reports. At least one reason may be responsible for the low rate of XBJ-associated SAEs in the patients with sepsis in the current trial. First, 93.0% of the patients with APACHE II scores less than 25 had a reduced risk.…”

Section: Discussionmentioning

confidence: 99%

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Effect of an Herbal-Based Injection on 28-Day Mortality in Patients With Sepsis

et al. 2023

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ImportancePrevious research has suggested that Xuebijing injection (XBJ), an herbal-based intravenous preparation, may reduce mortality among patients with sepsis.ObjectiveTo determine the effect of XBJ vs placebo on 28-day mortality among patients with sepsis.Design, Setting, and ParticipantsThe Efficacy of Xuebijing Injection in Patients With Sepsis (EXIT-SEP) trial was a multicenter, randomized double-blind, placebo-controlled trial conducted in intensive care units at 45 sites and included 1817 randomized patients with sepsis (sepsis 3.0) present for less than 48 hours. Patients aged 18 to 75 years with a Sequential Organ Failure Assessment score of 2 to 13 were enrolled. The study was conducted from October 2017 to June 2019. The final date of follow-up was July 26, 2019. Data analysis was performed from January 2020 to August 2022.InterventionsThe patients were randomized to receive either intravenous infusion of XBJ (100 mL, n = 911) or volume-matched saline placebo (n = 906) every 12 hours for 5 days.Main Outcomes and MeasuresThe primary outcome was 28-day mortality.ResultsAmong the 1817 patients who were randomized (mean [SD] age, 56.5 [13.5] years; 1199 [66.0%] men), 1760 (96.9%) completed the trial. In these patients, the 28-day mortality rate was significantly different between the placebo group and the XBJ group (230 of 882 patients [26.1%] vs 165 of 878 patients [18.8%], respectively; P &lt; .001). The absolute risk difference was 7.3 (95% CI, 3.4-11.2) percentage points. The incidence of adverse events was 222 of 878 patients (25.3%) in the placebo group and 200 of 872 patients (22.9%) in the XBJ group.Conclusions and RelevanceIn this randomized clinical trial among patients with sepsis, the administration of XBJ reduced 28-day mortality compared with placebo.Trial RegistrationClinicalTrials.gov Identifier: NCT03238742

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Effect of an Herbal-Based Injection on 28-Day Mortality in Patients With Sepsis

et al. 2023

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“…A Meta-analysis by Song et al demonstrated that combining XBJ with conventional intervention is superior to conventional intervention alone in treating MODS (Song et al, 2018). The benefits of XBJ to different organs (including lung, kidney, heart, and liver) were reported in a series of clinical studies (Fang and Wang, 2013;Wang et al, 2015;Zhang et al, 2016;Gao et al, 2018;Song et al, 2018) (Song et al, 2019). In a small-scale prospective, single-center, randomized doubleblinded trial, Gao et al found XBJ significantly lowered IL-1β, IL-8, and C-reactive protein in blood and up-regulated IL-10 in blood and decreased adverse events in patients with lung injury (Gao et al, 2018).…”

Section: Xbj and Organ Failurementioning

confidence: 96%

“…In a small-scale prospective, single-center, randomized doubleblinded trial, Gao et al found XBJ significantly lowered IL-1β, IL-8, and C-reactive protein in blood and up-regulated IL-10 in blood and decreased adverse events in patients with lung injury (Gao et al, 2018). Zhang et al found XBJ improved myocardial function in patients with septic myocardial injury, indicated by improving cardiac troponin I, N-terminal proB-type natriuretic peptide, and procalcitonin in blood samples of patients (Zhang et al, 2016).…”

Section: Xbj and Organ Failurementioning

confidence: 99%

Xuebijing Injection Maintains GRP78 Expression to Prevent Candida albicans–Induced Epithelial Death in the Kidney

Shang

Ren

et al. 2020

Front. Pharmacol.

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Sepsis and septic shock threaten the survival of millions of patients in the intensive care unit. Secondary fungal infections significantly increased the risk of mortality in sepsis patients. Chinese medicine Xuebijing injection (XBJ) has been routinely used as an add-on treatment to sepsis and septic shock in China. Our network pharmacology analysis predicted that XBJ also influences fungal infection, consisting with results of pioneer clinical studies. We conducted in vivo and in vitro experiments to verify this prediction. To our surprise, XBJ rescued mice from lethal Candida sepsis in a disseminated Candida albicans infection model and abolished the colonization of C. albicans in kidneys. Although XBJ did not inhibit the growth and the virulence of C. albicans in vitro, it enhanced the viability of 293T cells upon C. albicans insults. Further RNA-seq analysis revealed that XBJ activated the endoplasmic reticulum (ER) stress pathway upon C. albicans infection. Western blot confirmed that XBJ maintained the expression of GRP78 in the presence of C. albicans. Interestingly, key active ingredients in XBJ (C0127) mirrored the effects of XBJ. C0127 not only rescued mice from lethal Candida sepsis and prevented the colonization of C. albicans in kidneys, but also sustained the survival of kidney epithelial cells partially by maintaining the expression of GRP78. These results suggested that XBJ may prevent fungal infection in sepsis patients. Pre-activation of ER stress pathway is a novel strategy to control C. albicans infection. Network pharmacology may accelerate drug development in the field of infectious diseases.

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