Meta-Analysis
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World J Crit Care Med. Feb 4, 2014; 3(1): 34-41
Published online Feb 4, 2014. doi: 10.5492/wjccm.v3.i1.34
Ulinastatin for acute lung injury and acute respiratory distress syndrome: A systematic review and meta-analysis
Yu-Xin Leng, Shu-Guang Yang, Ya-Han Song, Xi Zhu, Gai-Qi Yao
Yu-Xin Leng, Shu-Guang Yang, Xi Zhu, Gai-Qi Yao, Department of Intensive Care Unit, Peking University Third Hospital, Beijing 100191, China
Ya-Han Song, Library of Peking University Third Hospital, Beijing 100191, China
Author contributions: Leng YX and Yang SG contributed to literature search and study selection; Leng YX and Song YH contributed to data extraction, analysis and interpretation; Yao GQ, Zhu X and Yao GQ contributed to study conception and design; Leng YX drafted the article; Yao GQ revised the article critically for important intellectual content.
Correspondence to: Gai-Qi Yao, MD, PhD, Associate Professor, Department of Intensive Care Unit, Peking University Third Hospital, A 49 North Garden Rd., Haidian District, Beijing 100191, China. yaogaiqi@yeah.net
Telephone: +86-10-82267280 Fax: +86-10-82267281
Received: June 5, 2013
Revised: October 5, 2013
Accepted: November 2, 2013
Published online: February 4, 2014
Processing time: 257 Days and 23.8 Hours
Abstract

AIM: To investigate the efficacy and safety of ulinastatin for patients with acute lung injury (ALI) and those with acute respiratory distress syndrome (ARDS).

METHODS: A systematic review of randomized controlled trials (RCTs) of ulinastatin for ALI/ARDS was conducted. Oxygenation index, mortality rate [intensive care unit (ICU) mortality rate, 28-d mortality rate] and length of ICU stay were compared between ulinastatin group and conventional therapy group. Meta-analysis was performed by using Rev Man 5.1.

RESULTS: Twenty-nine RCTs with 1726 participants were totally included, the basic conditions of which were similar. No studies discussed adverse effect. Oxygenation index was reported in twenty-six studies (1552 patients). Ulinastatin had a significant effect in improving oxygenation [standard mean difference (SMD) = 1.85, 95%CI: 1.42-2.29, P < 0.00001, I2 = 92%]. ICU mortality and 28-d mortality were respectively reported in eighteen studies (987 patients) and three studies (196 patients). We found that ulinastatin significantly decreased the ICU mortality [I2 = 0%, RR = 0.48, 95%CI: 0.38-0.59, number needed to treat (NNT) = 5.06, P < 0.00001], while the 28-d mortality was not significantly affected (I2 = 0%, RR = 0.78, 95%CI: 0.51-1.19, NNT = 12.66, P = 0.24). The length of ICU stay (six studies, 364 patients) in the ulinastatin group was significantly lower than that in the control group (SMD = -0.97, 95%CI: -1.20--0.75, P < 0.00001, I2 = 86%).

CONCLUSION: Ulinastatin seems to be effective for ALI and ARDS though most trials included were of poor quality and no information on safety was provided.

Keywords: Ulinastatin; Acute lung injury; Acute respiratory distress syndrome; Mortality; Oxygenation index

Core tip: Currently, many studies highlight the advantages of ulinastatin in lung protection, which is likely because acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) share a common pathogenesis with sepsis. We tried to provide more specific evidence on this practice by performing a meta-analysis. In our study (29 clinical trials included), we found that though all the studies were of low quality, ulinastatin might improve oxygenation and mortality and be truly effective in patients with ALI/ARDS.