Ulinastatin administration is associated with a lower incidence of acute kidney injury after cardiac surgery: a propensity score matched study

Abstract

BackgroundSystemic inflammation is involved in the development of acute kidney injury (AKI) after cardiac surgery with cardiopulmonary bypass (CPB). Ulinastatin, a urinary trypsin inhibitor (UTI), possesses a variety of anti-inflammatory effects. Therefore, we hypothesized that the administration of ulinastatin would reduce the occurrence of AKI in patients undergoing cardiac surgery with CPB.MethodsA retrospective propensity score matched analysis was used to evaluate the effect of ulinastatin on the development of AKI in patients undergoing first documented cardiac surgery with CPB between January 2008 and December 2012 in our hospital. Multiple logistic regression models were also employed to identify the association between UTI administration and development of AKI.ResultsA total of 2072 patients who underwent cardiac surgery with CPB met the inclusion criteria. Before propensity score matching, variables such as age, baseline creatinine, CPB duration, red blood cells transfused, and hematocrit were statistically different between the ulinastatin (UTI) group and the control group. On the basis of propensity scores, 409 UTI patients were successfully matched to the 409 patients from among those 1663 patients without UTI administration. After propensity score matching, no statistically significant differences in the baseline characteristics were found between the UTI group and the control group. The propensity score matched cohort analysis revealed that AKI and the need for renal replacement therapy occurred more frequently in the control group than in the UTI group (40.83 % vs. 30.32 %, P = 0.002; 2.44 % vs. 0.49 %, P = 0.02, respectively). However, there were no significant differences in mortality, length of intensive care unit stay, and length of hospital stay between the UTI group and the control group. Using multivariate logistic regression analysis, we found ulinastatin played a protective role in the development of AKI after cardiac surgery (odds ratio 0.71, 95 % confidence interval 0.56–0.90, P = 0.005).ConclusionsThis study shows that ulinastatin was associated with a lower incidence of AKI after cardiac surgery, suggesting that the administration of ulinastatin may be favorable for those patients undergoing cardiac surgery with CPB.

Reassessment of Acute Kidney Injury after Cardiac Surgery: A Retrospective Study

“…Compared with ulinastatin, aprotinin, a serine protease inhibitor derived from bovine lung tissue which has antifibrinolyticand anti-inflammatory effects (41), was mainly used to reduce perioperative bleeding and transfusion in cardiac surgery (42), but its renoprotectiverole is still controversial (43-45). In addition, the protective role of ulinastatin was also confirmed by a propensity score matched study (46). Further prospective, randomized, controlled trials are warranted to confirm the protective role of ulinastatin in the development of CSA-AKI.…”

Ulinastatin protects the lungs of COPD rats through the HMGB1/TLR4 signaling pathway

“…Therefore, the release of inflammatory mediators serves an important role in the occurrence and development of COPD; in addition, protease/anti-protease imbalance serves an important role in the pathogenesis of COPD (23). Previous studies have revealed that ulinastatin, a type of broad-spectrum protease inhibitor, can reduce tissue damage by inhibiting the release of inflammatory mediators, as observed in acute kidney injury (24), acute pancreatitis (25) and acute lung injury (7,26); however, there are very limited reports on the treatment of COPD with ulinastatin. Therefore, in the present study COPD rat models were established, and underwent ulinastatin treatment, to determine whether ulinastatin had an effect on COPD; which may eventually lead to the elucidation of the underlying disease mechanism.…”

High-dose ulinastatin improves postoperative oxygenation in patients undergoing aortic valve surgery with cardiopulmonary bypass: A retrospective study

“…A few studies have shown that ulinastatin may reduce the risk of acute kidney injury after CPB, but this finding is controversial because of the absence of a difference in the s-Cr or cystatin C concentration after aortic valve surgery with CPB. 22 , 23 …”