Siyi He1, Kailong Lin2, Ruiyan Ma3, Rufu Xu3, Yingbin Xiao4. 1. Department of Cardiovascular Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, China; Department of Cardiovascular Surgery, Chengdu Military General Hospital, Chengdu, Sichuan, China. 2. Department of Oncology, Xinqiao Hospital, Third Military Medical University, Chongqing, China. 3. Department of Cardiovascular Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, China. 4. Department of Cardiovascular Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, China. Electronic address: xiaoyingbin001@163.com.
Abstract
PURPOSE: Cardiopulmonary bypass (CPB) can cause systemic inflammatory responses and a series of subsequent complications that may harm patients. The aim of this study was to explore the effects of ulinastatin on inflammatory responses and clinical outcomes of CPB via a meta-analysis of published randomized controlled trials. METHODS: A literature search was conducted, both manually and by using the PubMed, EMBASE, Cochrane Library, and Web of Knowledge databases from inception to February 2013, to identify randomized controlled trials. The abstracted efficacy measures included changes in the plasma levels of cytokines (interleukin-6 [IL-6], IL-8, and tumor necrosis factor-α [TNF-α]) measured during the perioperative period and clinical indicators of efficacy, including the duration of mechanical ventilation and the length of intensive care unit stay. Ten ulinastatin-related randomized controlled trials related to cardiac surgeries involving CPB were selected. FINDINGS: In terms of cytokine concentrations, there were no significant differences between patients who received ulinastatin and those who received placebo before CPB. However, as the surgeries progressed, cytokine concentrations were all significantly lower in the ulinastatin group (P < 0.05 at 1 hour; P < 0.0001 at 6 hours), and the respective plasma concentrations returned to baseline values 24 hours after CPB. In terms of the clinical outcome indices, the length of intensive care unit stay was not significantly different, but the duration of mechanical ventilation (95% CI, -6.75 to -0.39; P = 0.03) was significantly shorter in the ulinastatin group. IMPLICATIONS: This meta-analysis found that changes in inflammatory cytokines occurred in a time-dependent manner and that the use of ulinastatin resulted in decreased duration of mechanical ventilation with CPB compared with placebo.
PURPOSE: Cardiopulmonary bypass (CPB) can cause systemic inflammatory responses and a series of subsequent complications that may harm patients. The aim of this study was to explore the effects of ulinastatin on inflammatory responses and clinical outcomes of CPB via a meta-analysis of published randomized controlled trials. METHODS: A literature search was conducted, both manually and by using the PubMed, EMBASE, Cochrane Library, and Web of Knowledge databases from inception to February 2013, to identify randomized controlled trials. The abstracted efficacy measures included changes in the plasma levels of cytokines (interleukin-6 [IL-6], IL-8, and tumor necrosis factor-α [TNF-α]) measured during the perioperative period and clinical indicators of efficacy, including the duration of mechanical ventilation and the length of intensive care unit stay. Ten ulinastatin-related randomized controlled trials related to cardiac surgeries involving CPB were selected. FINDINGS: In terms of cytokine concentrations, there were no significant differences between patients who received ulinastatin and those who received placebo before CPB. However, as the surgeries progressed, cytokine concentrations were all significantly lower in the ulinastatin group (P < 0.05 at 1 hour; P < 0.0001 at 6 hours), and the respective plasma concentrations returned to baseline values 24 hours after CPB. In terms of the clinical outcome indices, the length of intensive care unit stay was not significantly different, but the duration of mechanical ventilation (95% CI, -6.75 to -0.39; P = 0.03) was significantly shorter in the ulinastatin group. IMPLICATIONS: This meta-analysis found that changes in inflammatory cytokines occurred in a time-dependent manner and that the use of ulinastatin resulted in decreased duration of mechanical ventilation with CPB compared with placebo.
Authors: Markus Huber-Lang; Kristina N Ekdahl; Rebecca Wiegner; Karin Fromell; Bo Nilsson Journal: Semin Immunopathol Date: 2017-09-12 Impact factor: 9.623