Aim: Our aim was to evaluate the effect of ulinastatin on 28-day mortality in patients who developed multiple organ failure (MOF) related to their acute illness and were admitted to the intensive care unit (ICU).
Methods: We carried out a retrospective observational study of MOF patients in a general ICU of a tertiary care hospital in Japan from January 2009 to December 2012. The primary outcome was 28-day all-cause mortality. Secondary outcomes were ventilator-free days, ICU-free days, and vasopressor-free days at day 28. We investigated the association between ulinastatin treatment and outcomes using multivariable regression analysis.
Results: A total of 212 MOF patients were included, 79 (37%) of whom received ulinastatin. The median age was 70 years (interquartile range, 60-77) and median APACHE II score was 25 (interquartile range, 19-29). Overall 28-day mortality was 20%. There were no significant differences between the ulinastatin group and the control group in age, gender, or APACHE II score. The ulinastatin group had higher prevalence of sepsis (44% versus 22%, P = 0.001). Multivariable logistic regression analysis showed that ulinastatin was not associated with 28-day mortality (odds ratio = 1.22; 95% confidence interval, 0.54-2.79). Moreover, ulinastatin did not reduce the mortality in patients with sepsis (odds ratio = 1.92; 95% confidence interval, 0.52-7.13). However, ICU-free days and ventilator-free days was significantly fewer in the ulinastatin group than control group.
Conclusions: In this retrospective observational study, ulinastatin was not associated with mortality in elderly patients with established MOF, although it might be related to patient's utility.
Keywords: Multiple organ dysfunction syndrome; multiple organ failure; sepsis; systemic inflammation response syndrome; ulinastatin.