The effect of Ulinastatin on postoperative course in cardiopulmonary bypass patients in Asia: a meta-analysis of randomized controlled trials

Hu, Zhenyu; Qiaoli, Yuan; Chen, Guangxiang; Wang, Maohua

doi:10.1186/s13019-022-01811-z

Cited by 7 publications

(3 citation statements)

References 49 publications

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“…Nevertheless, the survival rate after 10 years of follow-up did not differ significantly between the two groups. It was consistent with a previous meta-analysis, which demonstrated that ulinastatin could reduce inflammatory cytokines but did not affect hospital mortality [35]. Generally, patients with AKI have a poor prognosis, which can lead to chronic kidney disease.…”

Section: Discussionsupporting

confidence: 92%

Effects of Ulinastatin on Postoperative Renal Function in Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass: A Prospective Cohort Study with 10-Year Follow-Up

Liu¹,

Lv²,

Fei³

et al. 2023

Cardiorenal Med

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Background: The present study aimed to explore the potential effect of ulinastatin on renal function and long-term survival in patients receiving cardiac surgery with CPB. Methods: This prospective cohort study was conducted at Fuwai Hospital, Beijing, China. The ulinastatin was applied after induction anesthesia. The primary outcome was the rate of new-onset postoperative acute kidney injury (AKI). Moreover, a ten-year follow-up was conducted until Jan 2021. Results: The rate of new-onset AKI was significantly lower in the ulinastatin group than in the control group (20.00% vs. 32.40%, p=0.009). There was no significant difference in RRT between the two groups (0.00% vs. 2.16%, p=0.09). The postoperative pNGAL and IL-6 levels were significantly lower in the ulinastatin group compared with the control group(pNGAL: p=0.007; IL-6: p=0.001). A significantly lower incidence of respiratory failure in the ulinastatin group compared with the control group (0.76% vs. 5.40%, p=0.02). The nearly 10-year follow-up(9.37,95CI%:9.17-9.57) survival rates did not differ significantly between the two groups ( p=0.076 ). Conclusions: Ulinastatin significantly reduced postoperative AKI and respiratory failure in patients receiving cardiac surgery with CPB. However, ulinastatin did not reduce ICU and hospital stay, mortality, and long-term survival rate. Key Words: ulinastatin, acute kidney injury, cardiac surgical procedures, cardiopulmonary bypass.

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Section: Discussionsupporting

confidence: 92%

Effects of Ulinastatin on Postoperative Renal Function in Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass: A Prospective Cohort Study with 10-Year Follow-Up

Liu¹,

Lv²,

Fei³

et al. 2023

Cardiorenal Med

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“…With its potential antiin ammatory effect, UTI has been used to treat a variety of diseases. For example, UTI can regulate innate immunity and proin ammatory response [19][20][21], and has been used to treat septicemia [22][23][24][25][26].…”

Section: Discussionmentioning

confidence: 99%

The role of TLR4/MyD88/NF-κB in the protective effect of ulinastatin on intestinal mucosal barrier in mice with sepsis

Song

Huang

et al. 2023

Preprint

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Objective To investigate the effect of TLＲ4 /MyD88 /NF-κB signaling pathway in the protective effect of ulinastatin on intestinal mucosal barrier in mice with sepsis. Methods The mouse model of sepsis was established by classical cecal ligation and perforation. Thirty-two SPF C57BL/6 mice were randomly divided into four groups with 8 in each: control group (Con group), ulinastatin group (Uti group), Uti +TLR4 agonist LPS group (Uti+LPS group) and LPS group. Mice in the Con group received the same volume of saline injected into the tail vein 2 hours after modeling; Mice in the Uti group received 10000 U/kg ulinastatin injected into tail vein 2 hours after modeling; Mice in the Uti+LPS group received LPS (5mg/kg) injected into tail vein at 0h after modeling, other procedures were the same as in the Uti group; Mice in the LPS group received LPS (5mg/kg) injected into tail vein 0h after modeling. The weight loss ratio of mice was calculated at 48h after surgery. All animals were sacrificed at 48h after surgery to assess the injury of jejunal mucosa, the levels of TNF-α, IL-6 and IL-1 β in tail vein, and the expression of TLR4, MyD88 and NF-κ B mRNA in small intestinal mucosa tissues using ELASA and RT-PCR. Results The weight change of mice in Uti at 48h after operation was significantly reduced than that of the Con (p=0. 008 vs. Con); while the weight change of mice in Uti+LPS group and LPS group was significantly increased than that of the Uti (P=0. 020, P=0. 036 vs. Uti). The scores of intestinal mucosal injury at 48 h of the Uti were significantly lower than that of the Con (p＜0.001 vs. Con)；while the scores of intestinal mucosal injuryat 48 h of the Uti+LPS were significantly higher than that of the Uti ( P=0.044 vs. Uti). The expression of TNF-α, IL-6 and IL-1 β in the Uti decreased significantly at 48h after surgery than that in the Con（P=0.001，P=0.014，P=0.004 vs. Con), while the expression of TNF-α, IL-6 and IL-1β in Uti+LPS increased significantly at 48h after surgery than that in the Uti（P=0.026，P=0.040，P=0.039 vs. Uti）. The expression of TLR4, MyD88 and NF-κB mRNA in Uti decreased significantly than that in the Con(P=0.001，P=0.021，P=0.007 vs. Con); while the expression of TLR4, MyD88 and NF-κB mRNA in Uti+LPS was higher than that in Uti (P=0.023，P=0.040，P=0.045 vs. Uti). Conclusion These findings indicate that the intestinal mucosal barrier protective effect against sepsis of ulinastatin may be mediated through the TLR4/MyD88/NF-κB pathway.

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“…8 Recent evidence has demonstrated that ulinastatin can reduce pulmonary injury, improve pulmonary function, 9 and improve intensive care unit length of stay in cardiopulmonary bypass patients. 10 However, little is known regarding whether distinct inflammatory subphenotypes exist in ATAAD patients and respond differently to pharmacotherapies.…”

mentioning

confidence: 99%

Anti-Inflammatory Effect of Ulinastatin on the Association Between Inflammatory Phenotypes in Acute Type A Aortic Dissection

Liu¹,

Qian²,

Shao³

et al. 2022

JIR

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Background: Acute type A aortic dissection (ATAAD) is a heterogeneous systemic inflammatory response syndrome. Identification of distinct inflammatory phenotypes may allow more precise therapy and improved care. We aim to investigate whether distinct inflammatory subphenotypes exist in ATAAD patients and respond differently to pharmacotherapies. Methods: Retrospective analysis of data sets was conducted from the Additive Anti-inflammatory Actions for Aortopathy & Arteriopathy (5A) III study. Inflammatory subphenotypes were derived among 2008 ATAAD patients who received surgical repair at 11 Chinese hospitals (2016-2020) using latent class analysis applied to 14 laboratory signatures within 6 hours of hospital admission. Outcomes included operative mortality (Society of Thoracic Surgeons definition), derived subphenotype frequency, and the potential consequences of phenotype frequency distributions on the treatment effects. Results: The median (interquartile range) age of patients was 54 (45-62) years, and 1423 (70.9%) were male. A two-class (two subphenotype) model was an improvement over a one-class model (P<•001), with 1451 (72.3%) patients in the hypoinflammatory subphenotype group and 557 (27.7%) in the hyperinflammatory subphenotype group. Patients with the hyperinflammatory subphenotype had higher operative mortality (71 [12.7%] vs 127 [8.8%]; P=0•007) than did those with the hypoinflammatory subphenotype. Furthermore, the interaction between ulinastatin treatment and subphenotype is not significant for operative mortality (P=0.15) but for ventilator time (P=0•04). Conclusion: Two subphenotypes of ATAAD were identified in the 5A cohort that correlated with clinical outcomes, with significant interaction effect between anti-inflammatory treatment and subphenotypes for ventilator time, suggesting these phenotypes may help in understanding heterogeneity of treatment effects. Trial Registration: Clinical Trials. Gov: number NCT04918108.

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The effect of Ulinastatin on postoperative course in cardiopulmonary bypass patients in Asia: a meta-analysis of randomized controlled trials

Cited by 7 publications

References 49 publications

Effects of Ulinastatin on Postoperative Renal Function in Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass: A Prospective Cohort Study with 10-Year Follow-Up

Effects of Ulinastatin on Postoperative Renal Function in Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass: A Prospective Cohort Study with 10-Year Follow-Up

The role of TLR4/MyD88/NF-κB in the protective effect of ulinastatin on intestinal mucosal barrier in mice with sepsis

Anti-Inflammatory Effect of Ulinastatin on the Association Between Inflammatory Phenotypes in Acute Type A Aortic Dissection

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