title: Does intraoperative ulinastatin improve postoperative clinical outcomes in patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  The systematic meta-analysis of randomized controlled trials (RCTs) evaluated the effects of intraoperative ulinastatin on early-postoperative recovery in patients undergoing cardiac surgery.
  
  
  METHODS
  RCTs comparing intraoperative ulinastatin with placebo in cardiac surgery were searched through PubMed, Cochrane databases, Medline, SinoMed, and the China National Knowledge Infrastructure (1966 to May 20th, 2013). The primary endpoints included hospital mortality, postoperative complication rate, length of stay in intensive care unit, and extubation time. The physiological and biochemical parameters illustrating postoperative cardiac and pulmonary function as well as inflammation response were considered as secondary endpoints.
  
  
  RESULTS
  Fifteen RCTs (509 patients) met the inclusion criteria. Ulinastatin did not affect hospital mortality, postoperative complication rate, or ICU length of stay but reduced extubation time. Ulinastatin also increased the oxygenation index on postoperative day 1 and reduced the plasma level of cardiac troponin-I. Additionally, ulinastatin inhibited the increased level of tumor necrosis factor-alpha, polymorphonuclear neutrophil elastase, interleukin-6, and interleukin-8 associated with cardiac surgery.
  
  
  CONCLUSIONS
  Ulinastatin may be of value for the inhibition of postoperative increased inflammatory agents and most likely provided pulmonary protective effects in cardiac surgery. However, larger adequately powered RCTs are required to define the clinical effect of ulinastatin on postoperative outcomes in cardiac surgery.
authors.affiliation: Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong 510080, China.
authors.forename: Qiu-Lan
authors.initials: QL
authors.lastname: He
authors.affiliation: School of Public Health, Sun Yat-sen University, No. 74 Zhongshan 2nd Road, Guangzhou, Guangdong 510080, China ; Guangzhou Municipal Center for Disease Control and Prevention, Guangzhou 0086-510080, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Zhong
authors.affiliation: Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong 510080, China.
authors.forename: Fang
authors.identifier: 0000-0002-0312-2412
authors.initials: F
authors.lastname: Ye
authors.affiliation: Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong 510080, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Wei
authors.affiliation: Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong 510080, China.
authors.forename: Wei-Feng
authors.initials: WF
authors.lastname: Liu
authors.affiliation: Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong 510080, China.
authors.forename: Mei-Na
authors.initials: MN
authors.lastname: Li
authors.affiliation: Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong 510080, China.
authors.forename: Qiao-Bo
authors.initials: QB
authors.lastname: Li
authors.affiliation: Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong 510080, China.
authors.forename: Wen-Qi
authors.initials: WQ
authors.lastname: Huang
authors.affiliation: Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong 510080, China.
authors.forename: Lai-Bao
authors.initials: LB
authors.lastname: Sun
authors.affiliation: Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong 510080, China.
authors.forename: Hai-Hua
authors.initials: HH
authors.lastname: Shu
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D052279:Creatine Kinase, MB Form / Q000097:blood; D003422:Critical Care; D006023:Glycoproteins / Q000008:administration & dosage*; D017052:Hospital Mortality; D006801:Humans; D007249:Inflammation; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D007432:Intraoperative Period; D007902:Length of Stay; D019272:Leukocyte Elastase / Q000097:blood; D010100:Oxygen / Q000737:chemistry; D011183:Postoperative Complications / Q000517:prevention & control; D011184:Postoperative Period; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood; D014361:Trypsin Inhibitors / Q000737:chemistry; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D006023:Glycoproteins; D015850:Interleukin-6; D016209:Interleukin-8; D019210:Troponin I; D014361:Trypsin Inhibitors; D014409:Tumor Necrosis Factor-alpha; D052279:Creatine Kinase, MB Form; D019272:Leukocyte Elastase; C028665:urinastatin; D010100:Oxygen
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