The anti-inflammatory effects of ulinastatin in trauma patients with hemorrhagic shock

Abstract

We investigated the use of ulinastatin in association with the suppression of polymorphonuclear leukocyte elastase (PMNE), tumor necrosis factor alpha (TNF-alpha) and interleukin 6 (IL-6), and its effects on the prognosis of patients with traumatic hemorrhagic shock. Nineteen patients who visited the emergency department for traumatic hemorrhagic shock were enrolled. Eleven patients were randomly selected to receive a total of 300,000 IU of ulinastatin. Measurements of serum PMNE, TNF-alpha and IL-6 were taken before ulinastatin treatment at 24 hr, two days, three days, and seven days after admission. We compared the Systemic Inflammatory Response Syndrome scores, Multiple Organ Dysfunction Syndrome scores and Acute Physiology, age, Chronic Health Evaluation III scores of the control and ulinastatin groups. There were no significant differences in baseline values, laboratory data, treatment or mortality between the two groups. The serum PMNE levels in the ulinastatin group were lower than in the control group on the second hospitalized day. Serum TNF-alpha and IL-6 levels in the ulinastatin group decreased 24 hr after admission but had no significance. It is suggested that ulinastatin treatment could decrease the serum PMNE levels in trauma patients with hemorrhagic shock at 48 hr after treatment.

Keywords: Interleukin-6; Leukocyte Elastase; Shock, Hemorrhagic; Tumor Necrosis Factor-alpha; Ulinastatin.

Fig. 1

The study design. GCS, Glascow coma scale; CPR, cardiopulmonary resuscitation; COPD, chronic obstructive pulmonary disease; TNF, tumor necrosis factor; IL, interleukin; PMNE, polymorphonuclear leukocyte elastase; SIRS, systemic inflammatory response syndrome; MODS, multiple organ dysfunction syndrome; APACHE, acute physiology, age, chronic health evaluation.

Fig. 2

(A) Effects of ulinastatin on serum TNF-α levels. (B) Changes in serum TNF-α levels after admission. HD0 means before injection of ulinastatin. HD, hospitalized day.

Fig. 3

(A) Effects of ulinastatin on serum IL-6 levels. (B) Changes in serum IL-6 levels after admission. HD0 means before infusion of ulinastatin. HD, hospitalized day.

Fig. 4

(A) Effects of ulinastatin on serum PMNE levels. (B) Changes in serum PMNE levels after admission. HD0 means before infusion of ulinastatin. HD, hospitalized day.