Qiying Fang1 
,
Xinghua Zhao2
For correspondence:- Qiying Fang Email: jjb763@163.com Tel:+8637163934118.
Received: 15 January 2017 Accepted: 24 March 2017 Published: 30 April 2017
Citation: Fang Q, Zhao X. Clinical effect of combined ulinastatin and continuous renal replacement therapy on management of severe sepsis with acute kidney injury. Trop J Pharm Res 2017; 16(4):925-930 doi: 10.4314/tjpr.v16i4.26
© 2017 The authors.
This is an Open Access article that uses a funding model which does not charge readers or their institutions for access and distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0) and the Budapest Open Access Initiative (http://www.budapestopenaccessinitiative.org/read), which permit unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited..
Purpose: To explore the effect of a combination of ulinastatin and continuous renal replacement therapy (CRRT) for the treatment of severe sepsis with acute kidney injury (SAKI).
Methods: Clinical data for 106 patients diagnosed with SAKI from April 2013 to May 2015 in the intensive care unit (ICU) of Affiliated Hospital of Zhengzhou University, Zhengzhou, China, were collected and randomly assigned into two groups: treatment and control groups. The general information on the two groups were comparable. All the patients received a comprehensive treatment program which included fluid resuscitation, antibiotics, nutritional support and CRRT. The patients in treatment group also received intravenous injection of 300 thousand units/10 mL ulinastatin thrice daily for 5 days. Serum levels of inflammatory cytokines, oxidative stress level, kidney and blood coagulation functions were assayed before and after treatment, using standard methodologies. In addition, adverse reactions and 28-day mortality were recorded.
Results: Levels of interleukin-6 (IL-6), tumor necrosis factor α (TNFα), serum C-reactive protein (CRP), procalcitonin (PCT), malondialdehyde (MDA), cystatin, blood urea nitrogen (BUN), prothrombin time (PT), activated partial thromboplastin time (APTT), serum creatinine (SCr) and urinary kidney injury molecule-1 (Kim-1) in the treatment group were significantly lower than those in the control group after ulinastatin treatment (p < 0.05). However, superoxide dismutase (SOD), fibrinogen (Fib) and total antioxidant capacity (T-AOC) in the treatment group were significantly higher in the control group after treatment (p < 0.05). No serious adverse drug reactions were seen in the two groups. In addition, there were no significant differences in 28-day mortality between the two groups.
Conclusion: These results suggest that ulinastatin combined with CRRT effectively decreases serum levels of inflammation in SAKI patients through a mechanism involving improvement of antioxidant capacity, reduction of oxidative stress, and enhancement of renal and coagulation functions
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