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Therapeutic Effects of Ulinastatin Combined with Continuous Blood Purification in Patients with Severe Sepsis

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Therapeutic Effects of Ulinastatin Combined with Continuous Blood Purification in Patients with Severe Sepsis Acta Medica Mediterranea, 2019, 35: 2649 THERAPEUTIC EFFECTS OF ULINASTATIN COMBINED WITH CONTINUOUS BLOOD PURIFICATION IN PATIENTS WITH SEVERE SEPSIS CHUNHUA NI1#, MEIMEI AI2#*, QING HUANG3, XIONGXIONG WANG4, HUAIBIN HAN5, RONGBING ZHOU6 1ICU Kunshan hospital affiliated to jiangsu university, Jiangsu215300, China -2 Department of Emergency Medicine, Xijing Hospital of the Fourth Military Medical University, Xi'an, Shaanxi 710032, China - 3Department of Emergency Medicine, Central Hospital of Zaozhuang Mining Group, Zaozhuang, Shandong 277000, China - 4Department of Intensive Care Medicine, the Second Hospital of Yinzhou District, Ningbo City, Zhejiang Province, 315040, China - 5ICU, Zhoukou Central Hospital, Zhoukou, Henan 466000, China - 6Department of Intensive Medicine, Guangrao County People's Hospital, Dongying City, Shandong Province, 257335, China #They contributed equally to this work ABSTRACT Objective: To explore the therapeutic effects of ulinastatin combined with continuous blood purification (CBP) in patients with severe sepsis. Methods: A total of 120 patients with severe sepsis admitted to the intensive care unit (ICU) of our hospital from October 2016 to September 2018 were enrolled in this study. These patients were divided into a control group and an observation according to the ran- dom number table method, 60 patients in each group. The control group was treated with continuous blood purification (CBP) alone. The observation group, on this basis, was added with ulinastatin treatment. The hospital stay, antibiotic use time, 30-day survival rate, the Acute Physiology, Age, Chronic Health Evaluation II (APACHE II) score, changes in the concentration of inflammatory mediators, as well as D-dimer and PCT levels before and after treatment were compared between the two groups. Results: The hospital stay and 30-day survival rate of the observation group were significantly shorter than the control group, and the differences were statistically significant (P<0.05). After treatment, the concentrations of inflammatory mediators IL-6 and TNF-α in the observation group were lower than the control group, and the differences were statistically significant (P<0.05). After treatment, the D-dimer and PCT levels decreased in both groups compared with the conditions before treatment, and the differences were statistically significant (P <0.05). Conclusion: Ulinastatin combined with continuous hemodialysis in the treatment of sepsis can reduce the number of inflamma- tory cells, significantly reduce patients' D-dimer and PCT levels. With significant therapeutic effects, this method can improve patients' survival rate and is worthy of clinical promotion. Keywords: Ulinastatin, continuous blood purification, sepsis, therapeutic effect. DOI: 10.19193/0393-6384_2019_5_417 Received November 30, 2018; Accepted February 20, 2019 Introduction Despite the development of medicine, the cause of sepsis has not yet been fully elucidated Sepsis is a systemic inflammatory response and the main clinical treatments currently used are syndrome (SIRS) induced by infection and a patho- fluid resuscitation, infection source control, anti-in- physiological process that damages tissues. It is a fective treatment, and internal environment stabili- common complication after shock, infection, burns zation. In the clinical practice, blood purification and major surgeries. It is a toxin that pathogens technology is often used for sepsis to reduce the produce in the patient's body and is present in pa- number of inflammatory cells and regulate immune tients' body in a systemic inflammatory response responses, but there are few reports on combination state. Sepsis is a common, frequently-occurring therapies for the disease(3-5). Ulinastatin, as an in- and dangerous disease in the ICU, with high mor - hibitor of various proteases, can effectively reduce tality rate and seriously threatening patients' life. inflammatory responses and protect the body and The mortality rate is as high as 35%~70%(1-2). organs(6). 2650 Chunhua Ni, Meimei Ai et Al In recent years, our hospital has used ulinas- cording to the Guidelines for the Treatment of Se- tatin combined with continuous haemodialysis to vere Sepsis/Septic Shock. The treatments included treat severe sepsis and achieved good results. We controlling infection sources, protecting organs, selected 120 cases of severe sepsis admitted to our resuscitating body fluids, controlling primary dis- hospital from August 2016 to July 2018 as the sub- eases, and actively maintaining a stable internal jects of this study, to explore the value of ulinas- environment. The control group was treated with tatin combined with continuous blood purification CBP in the continuous venous-venous hemofil- (CBP) in patients with severe sepsis. The details tration mode. The parameters setting: blood flow are reported as follows. rate 170~220 mL/min, replacement fluid input rate 35 mL/(kg·h), without anticoagulant therapy. Data and methods The observation group, on this basis, was added with ulinastatin treatment (Guangdong Techpool General data Bio-pharma Co., Ltd, lot No. 20151201, specifica- A total of 120 patients with severe sepsis ad- tion 100,000 IU/vail), 200,000 IU ulinastatin was mitted to the ICU of our hospital from October 2016 dissolved in 10 mL normal saline, intravenous in- to September 2018 were included as the subjects jections were given 3 times a day. Both groups of of this study, and were divided into a control group patients were treated continuously for 7 days. and an observation group by the randomized block method, 60 cases in each group. The control group Observation measures consisted of 40 males and 20 females, aged 30~69, The hospital stay, antibiotic use time, 30-day mean (56.1±9.2) years old; the APACHE II score survival rate and APACHE II score after 7 days of (26.8±6.1) points; underlying diseases: pulmonary continuous treatment were observed and compared infection (30 cases), abdominal infection (21 cases) between the two groups. At the same time, the and other infections (9 cases); among the 60 cases, changes in inflammatory mediator concentrations 35 received mechanical ventilation. The observation and the D-dimer and procalcitonin (PCT) levels in group consisted of 42 males and 18 females, aged the two groups before and after treatment were ob- 30~69, mean (55.9±8.9) years old; the APACHE II served and compared. score (26.7±6.0) points; underlying diseases: pulmo- nary infection (30 cases), abdominal infection (19 Statistical analysis cases) and other infections (11 cases); among the SPSS 17.0 statistical software was used for 60 cases, 33 received mechanical ventilation. There data analysis. Measurement data were expressed were no significant differences in sex, age, under - by x±s and analysed by the t-test. Count data were lying diseases, APACHE II scores between the two expressed by ratio or constituent ratio and analysed groups (P >0.05). The two groups were comparable. by the x 2 test. P<0.05 was considered statistically Inclusion criteria. All patients voluntarily par - significant. ticipated in this study with informed consent and the agreement from their guardians, all meeting the fol- Results lowing criteria. • All patients met the relevant provisions of Comparison of observation measures between Guidelines for the Treatment of Severe Sepsis / Sep- the two groups tic Shock issued by Chinese Society of Critical Care The hospital stay of the observation group was Medicine (CSCCM). significantly shorter than the control group, and the • Excluding patients with severe liver or kidney difference was statistically significant (P<0.05). How- function damage or other serious diseases. ever, there was no significant difference in the antibi- • Excluding patients with malignant tumours, otic use time between the two groups (P>0.05). The blood system diseases, and those who had recently 30-day survival rate of the observation group was sig- used drugs that affect blood coagulation. nificantly higher than the control group, and the dif- • Excluding female patients during lactation ference was statistically significant (P<0.05). After 7 and pregnancy. days of treatment, the APACHE II score of the obser - vation group was significantly lower than the control Treatment group, and the difference was statistically significant All patients underwent basic treatments ac- (P<0.05). See Table 1. Therapeutic effects of ulinastatin combined with continuous blood purification in patients with severe sepsis 2651 Hospital Antibiotic 30-day APACHE Discussion Group n stay use time survival rate II score (x±s, d) (x±s, d) [n(%)] (x±s, point) Observation Severe sepsis is a systemic inflammatory re- group 60 14.2±1.9 13.9±1.5 50(83.8) 14.8±3.2 sponse syndrome (SIRS) caused by infection, clini- Control group 60 22.2±2.0 13.8±1.7 36(60.0) 20.2±5.3 cally confirmed to have bacteria or highly suspicious t/x2 5.518 0.264 4.944 5.398 infections. Sepsis, with a high incidence in the ICU, can trigger systemic immune dysfunction, induce p <0.05 >0.05 <0.05 <0.05 multiple organ failure and even death (7-8). The patho- Table. 1: Table 1 Comparison of observation measures genesis of sepsis is complicated. Infection stimulation between the two groups. can lead to the activation of various inflammatory factors, releasing a large amount of tumour necrosis Comparison of the concentrations of inflam- factor-α, Fas ligand, granzyme, interleukin-1, and ox- matory mediators IL-6 and TNF-α between the ygen radicals, etc., and forming a cascade
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