Outcome of Ulinastatin vs Metabolic Resuscitation using Ascorbic Acid, Thiamine and Glucocorticoid in Early Treatment of Sepsis- A Randomised Controlled Trial
Introduction: Sepsis is one the most common cause of morbidity and mortality worldwide. Sepsis and septic shock are life-threatening disease which increases mortality with circulatory, cellular and metabolic abnormalities. Urinary trypsin inhibitor is an important protease inhibitor found in hum...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2021-05-01
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| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://www.jcdr.net/articles/PDF/14946/47233_CE[Ra1]_F[IK]%20PF1%20AKA_[IK]_PN(KM).pdf |
| Summary: | Introduction: Sepsis is one the most common cause of
morbidity and mortality worldwide. Sepsis and septic shock
are life-threatening disease which increases mortality with
circulatory, cellular and metabolic abnormalities. Urinary trypsin
inhibitor is an important protease inhibitor found in human blood
and urine, it is known as Ulinastatin (ULI) or bikunin. It is an
acidic glycoprotein (molecular weight 30 kDa) and Kunitz-type
serine protease inhibitor. It is derived from the larger inter-αtrypsin inhibitor molecule by action of neutrophil elastase in the
presence of inflammation, and is believed to play an important
anti-inflammatory role.
Aim: To compare the outcome of intravenous ULI (protease
inhibitor known as urinary trypsin inhibitor) versus the
combination of hydrocortisone, ascorbic acid (vitamin C) and
thiamine regarding outcome in sepsis and septic shock.
Materials and Methods: In this randomised controlled trial
conducted between July 2018 to June 2019 on total 60 sepsis
patients were included and divided into two equal groups. Group
A patients received combination of intravenous Hydrocortisone,
Ascorbic acid and Thiamine (HAT) and group B Ulinastatin
received intravenous Intensive Care Unit(ICU). Baseline
demographic, clinical and laboratory data were recorded along
with Acute Physiology and Chronic Health Evaluation (APACHE)
2 and Sequential Organ Failure Assessment (SOFA) scoring
system at the time of admission in ICU. All statistical test were
performed using SPSS 21.0 windows software. Comparisons
between groups were assessed by using student t-test and chisquare test.
Results: Mean age was comparable in both the groups
(36.7±12.5 years in group A vs 37.5±12.9 years in group B). SOFA
Score were significantly lower in group B as compared to group
A on day 3 (7.76±3.67 vs 12.03±4.77) and day 5 (4.79±4.02 vs
12.10±7.36). Rate of reduction in serum procalcitonin level was
also found to be significant in group B (p=0.008) as compared
to group A (p=0.103). Lactate clearance rate was also fast in
group B as compared to group A on day 3 and day 5. There
was significant mortality benefit in group B (20%) as compared
to group A (50%). Patients were followed up for 28 days till the
start of treatment.
Conclusion: This study showed that the ULI may play a beneficial
role in early management of sepsis and septic shock. |
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| ISSN: | 2249-782X 0973-709X |