Effect of ulinastatin combined with thymosin alpha1 on sepsis: A systematic review and meta-analysis of Chinese and Indian patients

Purpose: To assess the effects of urinary trypsin inhibitor (UTI) ulinastatin combined with thymosin alpha1 (T alpha 1) on sepsis. Materials and methods: The meta-analysis included 8 randomized controlled trials (N - 1112 patients) on UTI-based therapy for sepsis published before July 10, 2016. Two investigators independently extracted data and assessed the quality of each study. The short-term mortality rate, duration of mechanical ventilator and vasopressor use, length of intensive care unit stay, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and differences in inflammatory cytokines (interleukin [IL]-6, IL-10, and tumor necrosis factor alpha) were assessed using statistical software. Results: Treatment of UTI combined with T alpha 1 (UTI + T alpha 1) decreased the short-term mortality rate in septic patients by 36%, 35%, and 31% for 28, 60, 90 days, respectively. UTI + T alpha 1 decreased the duration of mechanical ventilation, APACHE II score, and levels of IL-6 and tumor necrosis factor alpha. Treatment of UTI + T alpha 1 did not reduce the duration of vasopressor use and length of intensive care unit stay, or increase IL-10 levels. Because of the high heterogeneity of the included trials, the results should be carefully assessed. Conclusions: Treatment of UTI + T alpha 1 can suppress the production of proinflammatory cytokines, decrease the APACHE II score, shorten the duration of mechanical ventilation, and improve the 28-day survival rate. (C) 2016 Elsevier Inc. All rights reserved.