title: Ulinastatin, a protease inhibitor, may inhibit allogeneic blood transfusion-associated pro-inflammatory cytokines and systemic inflammatory response syndrome and improve postoperative recovery.
abstract: BACKGROUND
  The aim of this study was to investigate the effects of ulinastatin, a protease inhibitor, and blood transfusion on perioperative surgical complications, changes of systemic inflammatory response syndrome (SIRS) scores, and levels of interleukin-6 (IL-6), interleukin-8 (IL-8) and tumour necrosis factor-α (TNF-α) in patients undergoing liver resection.
  
  
  METHODS
  Patients aged 18-65 years were enrolled and divided into four groups (12 patients in each group): a control group, a group given ulinastatin (UTI group), a group given blood transfusion (BT group), and a group given both blood transfusion and ulinastatin (BT+UTI group). Patients were randomised to receive ulinastatin or not, whereas blood transfusion was administered based on a transfusion trigger. Ulinastatin was given at a dose of 100,000 units/10 kg, infused 15 min before allogeneic blood transfusion or after completion of the liver resection. The patients were followed up for 3 days to record surgical complications, SIRS scores and levels of IL-6, IL-8 and TNF-α.
  
  
  RESULTS
  Forty-four patients were included in the data analysis. The SIRS rate (SIRS scores≥2) was significantly higher in the BT groups than in the control group at 6 hours and on day 3 after surgery and was significantly lower in the BT+UTI group than in the BT group on day 3 after surgery. Allogeneic blood transfusion significantly increased and ulinastatin significantly decreased postoperative levels of IL-6, IL-8, and TNF-α. The length of stay in hospital was significantly longer in the BT groups than in the control group but was not significantly different between the BT+UTI and BT groups.
  
  
  CONCLUSIONS
  A single dose of ulinastatin before allogeneic blood transfusion may lower the rate of postoperative SIRS and levels of IL-6, IL-8 and TNF-α associated with allogeneic blood transfusion and improve patients' postoperative recovery.
authors.affiliation: Department of Anaesthesiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
authors.forename: Haihua
authors.initials: H
authors.lastname: Shu
authors.affiliation: Department of Anaesthesiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
authors.forename: Kuanzhi
authors.initials: K
authors.lastname: Liu
authors.affiliation: Department of Anaesthesiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
authors.forename: Qiulan
authors.initials: Q
authors.lastname: He
authors.affiliation: School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China Guangzhou Municipal Centre of Disease Control and Prevention, Guangzhou, Guangdong, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Zhong
authors.affiliation: Department of Anaesthesiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
authors.forename: Lu
authors.initials: L
authors.lastname: Yang
authors.affiliation: Department of Anaesthesiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
authors.forename: Qiaobo
authors.initials: Q
authors.lastname: Li
authors.affiliation: Department of Anaesthesiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
authors.forename: Weifeng
authors.initials: W
authors.lastname: Liu
authors.affiliation: Department of Anaesthesiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Ye
authors.affiliation: Department of Anaesthesiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
authors.forename: Wenqi
authors.initials: W
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003102:Colloids / Q000008:administration & dosage; D000077324:Crystalloid Solutions; D016207:Cytokines / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006023:Glycoproteins / Q000008:administration & dosage / Q000627:therapeutic use*; D006498:Hepatectomy; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D007552:Isotonic Solutions / Q000008:administration & dosage; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010949:Plasma; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D011292:Premedication; D011446:Prospective Studies; D011480:Protease Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D065227:Transfusion Reaction; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D003102:Colloids; D000077324:Crystalloid Solutions; D016207:Cytokines; D006023:Glycoproteins; C508600:IL6 protein, human; D015850:Interleukin-6; D016209:Interleukin-8; D007552:Isotonic Solutions; D011480:Protease Inhibitors; D014409:Tumor Necrosis Factor-alpha; C028665:urinastatin