Effect of Ulinastatin on serum Hpopolysaccharide-binding protein and soluble CD14 in severe septic patients

Objective To investigate the changes of serum lipopolysaccharide-binding protein (LBP) and soluble CD14 (sCD14) levels in severe sepsis patients, and to evaluate the efficacy and the possible mechanism of ulinastatin in those patients. Method Blood samples were obtained within 24 hours after onset of severe sepsis (day 0) and at 2 days, 3 days and 6 days. Serum concentration of LBP and sCDI4 were measured by enzyme linked immunosorbent assay (ELISA). Forty patients were randomly divided into ulinastatin treatment group (group U) and control group (group C). Patients in group U received ulinastatin 200 000 units intravenously twice a day for 5 days, while those in group C received equal quantity of normal saline as placebo. Before treatment, APACHEⅡscores were recorded. The dynamic changes of serum LBP and sCD14 were observed in those patients. Mortality rate was compared at 28 days after treatment between the two groups. Results Significantly higher serum concentration of LBP and sCD14 were found in severe sepsis patients (P0.01). The concentration of LBP and sCD14 elevated to the maximum at 2 days and then tended downwards. At 6 days, the concentration of LBP in severe sepsis patients was stilt higher than that in the healthy subjects, while the concentration of sCD14 was no difference between the severe sepsis patients and the healthy indiridual. There was no significant difference in LBP serum levels between non-survivors and survivors. But sCD14 serum levels were higher in non-survivors at 6 days. Before treatment, the APACHE score of group U was similar to that of and group C (P0.05). Mortality rate at 28 days was 18.2% (4/22) in group U and lower than that in group C, 50.0% (9/18)(P0.05). Conclusions Significantly higher serum concentration of LBP and sCDi4 was found in severe sepsis patients. Serum sCD14 level can be regarded as a prognostic marker in patients with severe sepsis. Ulinastatin improved the out come of patients with severe sepsis, reduced 28-day mortality of those patients. The potential mechanism was likely associated with the change of serum sCD14 level after using Ulinastatin.