Clinical Efficacy of Ulinastatin in the Treatment of Unliquefied Pyogenic Liver Abscess Complicated by Septic Shock: A Randomized Controlled Trial

Overview

Journal Immun Inflamm Dis

Specialties Allergy & Immunology
Infectious Diseases

Date 2023 Apr 27

PMID 37102655

Authors

Mingfeng Guo

Bing Zhou

Affiliations

Soon will be listed here.

Abstract

Introduction: This study determined the therapeutic effect of ulinastatin (UTI) on unliquefied pyogenic liver abscesses complicated by septic shock (UPLA-SS).

Methods: This was a randomized controlled trial involving patients with UPLA-SS who underwent treatment at our hospital between March 2018 and March 2022. The patients were randomly divided into control (n = 51) and study groups (n = 48). Both groups received routine treatment, but the study group received UTI (200,000 units q8h for >3 days). Differences in liver function, inflammatory indices, and effectiveness between the two groups were recorded.

Results: Following treatment, the white blood cell count, and lactate, C-reactive protein, procalcitonin, tumor necrosis factor-α, and interleukin-6 levels were significantly decreased in all patients compared to the admission values (p < .05). The study group had a faster decline with respect to the above indices compared to the control group (p < .05). The study group length of intensive care unit stay, fever duration, and vasoactive drug maintenance time were all significantly shorter than the control group (p < .05). The total bilirubin, alanine aminotransferase, and aspartate aminotransferase levels were significantly lower in the study and control groups after treatment compared to before treatment (p < .05); however, the study group had a faster recovery of liver function than the control group (p < .05). The overall mortality rate was 14.14% (14/99); 10.41% of the study group patients died and 17.65% of the control group patients died, but there was no statistically significant difference between the two groups (p > .05).

Conclusion: UTI combined with conventional treatment significantly controlled the infection symptoms, improved organ function, and shortened the treatment time in patients with UPLA-SS.

Citing Articles

Ulinastatin treatment mitigates glycocalyx degradation and associated with lower postoperative delirium risk in patients undergoing cardiac surgery: a multicentre observational study.

Ran X, Xu T, Liu J, Yang S, Luo F, Wu R Crit Care. 2025; 29(1):52.

PMID: 39881341 PMC: 11776223. DOI: 10.1186/s13054-025-05296-9.

Ulinastatin shortens the length of ICU stay in critical patients with organ failure: A 7-year real-world study.

Wu L, Xu D, Liu Y, Li W, Jiang W, Tao X Sci Prog. 2024; 107(3):368504241272696.

PMID: 39140832 PMC: 11325468. DOI: 10.1177/00368504241272696.

An Applied Study of Ulinastatin in Pain Management After Hip Replacement: Impact on Opioid Use.

Hou C, Liu Y, Su X, Tian S, Li Y J Pain Res. 2024; 17:2571-2584.

PMID: 39132292 PMC: 11316474. DOI: 10.2147/JPR.S469646.

Clinical efficacy of ulinastatin in the treatment of unliquefied pyogenic liver abscess complicated by septic shock: A randomized controlled trial.

Guo M, Zhou B Immun Inflamm Dis. 2023; 11(4):e822.

PMID: 37102655 PMC: 10108682. DOI: 10.1002/iid3.822.

References

Gavelli F, Castello L, Avanzi G . Management of sepsis and septic shock in the emergency department. Intern Emerg Med. 2021; 16(6):1649-1661. PMC: 8354945. DOI: 10.1007/s11739-021-02735-7. View

Al-Shamsi M, Amin A, Adeghate E . Vitamin E ameliorates some biochemical parameters in normal and diabetic rats. Ann N Y Acad Sci. 2006; 1084:411-31. DOI: 10.1196/annals.1372.033. View

Longworth S, Han J . Pyogenic liver abscess. Clin Liver Dis (Hoboken). 2019; 6(2):51-54. PMC: 6490642. DOI: 10.1002/cld.487. View

Guo X, Wang Z, Liu Y, Xu Q, Su L, Wu F . [Mechanism of continuous venovenous hemofiltration combined with ulinastatin for the treatment of septic shock]. Nan Fang Yi Ke Da Xue Xue Bao. 2015; 35(8):1189-92, 1196. View

Xie J, Wang H, Kang Y, Zhou L, Liu Z, Qin B . The Epidemiology of Sepsis in Chinese ICUs: A National Cross-Sectional Survey. Crit Care Med. 2019; 48(3):e209-e218. DOI: 10.1097/CCM.0000000000004155. View

Khim G, Em S, Mo S, Townell N . Liver abscess: diagnostic and management issues found in the low resource setting. Br Med Bull. 2019; 132(1):45-52. PMC: 6992887. DOI: 10.1093/bmb/ldz032. View

Wu J, Zhou L, Liu J, Ma G, Kou Q, He Z . The efficacy of thymosin alpha 1 for severe sepsis (ETASS): a multicenter, single-blind, randomized and controlled trial. Crit Care. 2013; 17(1):R8. PMC: 4056079. DOI: 10.1186/cc11932. View

Kumar S, Perween N, Omar B, Kothari A, Satsangi A, Jha M . Pyogenic liver abscess: Clinical features and microbiological profiles in tertiary care center. J Family Med Prim Care. 2020; 9(8):4337-4342. PMC: 7586609. DOI: 10.4103/jfmpc.jfmpc_927_20. View

Li C, Ma D, Chen M, Zhang L, Zhang L, Zhang J . Ulinastatin attenuates LPS-induced human endothelial cells oxidative damage through suppressing JNK/c-Jun signaling pathway. Biochem Biophys Res Commun. 2016; 474(3):572-578. DOI: 10.1016/j.bbrc.2016.04.104. View

10.

Zhang S, Zhang X, Wu Q, Zheng X, Dong G, Fang R . Clinical, microbiological, and molecular epidemiological characteristics of -induced pyogenic liver abscess in southeastern China. Antimicrob Resist Infect Control. 2019; 8:166. PMC: 6819602. DOI: 10.1186/s13756-019-0615-2. View

11.

Roediger R, Lisker-Melman M . Pyogenic and Amebic Infections of the Liver. Gastroenterol Clin North Am. 2020; 49(2):361-377. DOI: 10.1016/j.gtc.2020.01.013. View

12.

Liu Y, Li Z, Liu A, Xu J, Li Y, Liu J . Early percutaneous catheter drainage in protecting against prolonged fever among patients with pyogenic liver abscess: a retrospective cohort study. Ann Med. 2022; 54(1):2269-2277. PMC: 9387318. DOI: 10.1080/07853890.2022.2110612. View

13.

Chang P, Liu J, Yu Y, Cui S, Guo Z, Chen G . Alpha-Lipoic Acid Suppresses Extracellular Histone-Induced Release of the Infammatory Mediator Tumor Necrosis Factor-α by Macrophages. Cell Physiol Biochem. 2017; 42(6):2559-2568. DOI: 10.1159/000480217. View

14.

Zimmermann L, Wendt S, Lubbert C, Karlas T . Epidemiology of pyogenic liver abscesses in Germany: Analysis of incidence, risk factors and mortality rate based on routine data from statutory health insurance. United European Gastroenterol J. 2021; 9(9):1039-1047. PMC: 8598960. DOI: 10.1002/ueg2.12132. View

15.

Yoo J, Lee T, Kyoung D, Park M, Kim S, Kim Y . A population-based study of pyogenic liver abscess in Korea: Incidence, mortality and temporal trends during 2007-2017. Liver Int. 2021; 41(11):2747-2758. DOI: 10.1111/liv.15034. View

16.

Linder A, Russell J . An exciting candidate therapy for sepsis: ulinastatin, a urinary protease inhibitor. Intensive Care Med. 2014; 40(8):1164-7. DOI: 10.1007/s00134-014-3366-9. View

17.

Jiang W, Yu X, Sun T, Chai Y, Chang P, Chen Z . ADJunctive Ulinastatin in Sepsis Treatment in China (ADJUST study): study protocol for a randomized controlled trial. Trials. 2018; 19(1):133. PMC: 5822617. DOI: 10.1186/s13063-018-2513-y. View

18.

Serraino C, Elia C, Bracco C, Rinaldi G, Pomero F, Silvestri A . Characteristics and management of pyogenic liver abscess: A European experience. Medicine (Baltimore). 2018; 97(19):e0628. PMC: 5959441. DOI: 10.1097/MD.0000000000010628. View

19.

Singer M, Deutschman C, Seymour C, Shankar-Hari M, Annane D, Bauer M . The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8):801-10. PMC: 4968574. DOI: 10.1001/jama.2016.0287. View

20.

Yin D, Ji C, Zhang S, Wang J, Lu Z, Song X . Clinical characteristics and management of 1572 patients with pyogenic liver abscess: A 12-year retrospective study. Liver Int. 2020; 41(4):810-818. PMC: 8048845. DOI: 10.1111/liv.14760. View