Clinical effect of combined ulinastatin and continuous renal replacement therapy on management of severe sepsis with acute kidney injury

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.Keywords: Ulinastatin, Continuous renal replacement therapy, Sepsis, Acute kidney injury, Inflammatory cytokines