Director, Department of Critical Care Medicine, Medanta Institute of Critical Care and Anaesthesiology, Medanta, The Medicity, Gurugram, Haryana.
Head, Department of Neuro Trauma Intensive Care Unit, Ruby Hall Clinic.
J Assoc Physicians India. 2023 Feb;71(2):11-12. doi: 10.5005/japi-11001-0181.
To assess the impact on 30-day mortality with ulinastatin (ULI) used as add-on to standard of care (SOC) compared to SOC alone in coronavirus disease (COVID-19) patients requiring admission to the intensive care unit (ICU).
In this multicentric, retrospective study, we collected data on clinical, laboratory, and outcome parameters in patients with COVID-19. Thirty-day mortality outcome was compared among patients treated with SOC alone and ULI used as add-on to SOC. Odds ratio (OR) and 95% confidence intervals (CI) were determined to identify the predictors of 30-day mortality.
Ninety-four patients were identified and enrolled in both groups with comparable baseline parameters. On univariate analysis, 30-day mortality was significantly lower in ULI plus SOC group than SOC alone group (36.2 vs 51.1%, OR 0.54, 95% CI 0.30-0.97, p = 0.040). The effect on mortality was more pronounced in patients who did not require intubation (10.9 vs 34.0%, OR 0.24, 95% CI 0.09-0.66, p = 0.006) and with early administration (within 72 hours of admission) of ULI (30.7 vs 57.9%, OR 0.32, 95% CI 0.11-0.91, p = 0.032). On multivariate analysis, only intubation predicted mortality (adjusted OR 10.13, 95% CI 3.77-27.25, p<0.0001) and the effect of ULI on survival was not significant (adjusted OR 0.58, 95% CI 0.22-1.52, p = 0.270).
Given the limited options for COVID-19 patients treated in ICU, early administration of ULI may be helpful, especially in patients not requiring intubation to improve the outcomes. Further, a large, randomized study is warranted to confirm these findings.
评估乌司他丁（ULI）作为标准治疗（SOC）的附加治疗与单独 SOC 相比对需要入住重症监护病房（ICU）的冠状病毒病（COVID-19）患者的 30 天死亡率的影响。
在这项多中心、回顾性研究中，我们收集了 COVID-19 患者的临床、实验室和结局参数数据。比较了单独接受 SOC 治疗和 SOC 附加 ULI 治疗的患者的 30 天死亡率结局。确定比值比（OR）和 95%置信区间（CI）以确定 30 天死亡率的预测因素。
确定了 94 名患者并将其纳入两组，两组基线参数具有可比性。在单变量分析中，与单独 SOC 组相比，ULI 加 SOC 组的 30 天死亡率显著降低（36.2%比 51.1%，OR 0.54，95%CI 0.30-0.97，p=0.040）。在未接受插管的患者（10.9%比 34.0%，OR 0.24，95%CI 0.09-0.66，p=0.006）和 ULI 早期（入院后 72 小时内）给药的患者中，这种对死亡率的影响更为明显（30.7%比 57.9%，OR 0.32，95%CI 0.11-0.91，p=0.032）。多变量分析显示，只有插管预测死亡率（调整后的 OR 10.13，95%CI 3.77-27.25，p<0.0001），而 ULI 对生存的影响不显著（调整后的 OR 0.58，95%CI 0.22-1.52，p=0.270）。
鉴于 ICU 中 COVID-19 患者的治疗选择有限，早期给予 ULI 可能有助于改善结局，尤其是在不需要插管的患者中。还需要进行更大规模的随机研究来证实这些发现。
