An exciting candidate therapy for sepsis: ulinastatin, a urinary protease inhibitor

Excerpt

In a recent issue of Intensive Care Medicine (ICM), Karnad et al. [1] reported a randomized, double-blind, placebo-controlled multicenter trial (RCT) evaluating the efficacy of a urinary protease inhibitor (ulinastatin) compared to placebo in patients with severe sepsis. This RCT was conducted in the intensive care units (ICUs) of seven tertiary care hospitals in India including 114 patients. Patients received intravenous ulinastatin or placebo twice daily for 5 days. Ulinastatin was associated with significantly decreased mortality (7.3 vs. 20.3 %, P = 0.042), with 25 % of the deaths in the ulinastatin group judged related to ARDS compared to 42 % in the placebo group, lower frequency of new organ dysfunction, and shorter durations of mechanical ventilation and hospital stay compared to placebo. Furthermore, in stepwise multiple logistic regression (adjusted for age, gender, GCS, specific organ failures, number of organ failures, need for vasopressor, and mechanical ventilation), treatment with ulinastatin was associated with a statistically significant decrease in mortality. …