Ulinastatin and/or Thymosin Alpha1 for Severe XXXX : A Systematic Review and Meta-analysis.

@entity1 @entity295 @entity18274
OBJECTIVE: Ulinastatin (UTI) and thymosin alpha1 (Ta1) have been investigated for their immunoregulatory properties in @entity1 with severe @entity295 . However, it is unclear whether immunomodulatory therapy using @entity18274 ( @entity18274 ), UTI alone (UA), or Ta1 alone (TA) improves the disease outcome. The objective of this study was to analyze the effectiveness of @entity18274 , UA, and TA for the treatment of severe @entity295 . METHODS: PubMed, Embase, and Cochrane Library databases were investigated from inception to September 2015. Randomized controlled trials (RCTs) examining the treatment of @entity1 with severe @entity295 by @entity18274 , UA, and TA were defined as eligible. Data were analyzed with Review Manager 5.3, and the RCTs were evaluated by the Cochrane Handbook 5.1.0. The quality of the evidence was evaluated according to the grading of recommendations, assessment, development, and evaluations (GRADE). RESULTS: Ten articles and 12 studies were included in this systematic review and meta-analysis. The primary outcome measures indicated that @entity18274 was associated with significantly lower 28-day mortality [risk ratio (RR) = 0.67, 95% confidence interval (CI) (0.57, 0.80), P<0.00001; n = 915; GRADE rating: moderate] and 90-day mortality [RR = 0.75, 95% CI (0.61, 0.93), P = 0.009; n = 547; GRADE rating: moderate]; UA was associated with no significant difference in the 28-day mortality [RR = 0.60, 95% CI (0.30, 1.20), P = 0.15; n = 182; GRADE rating: low], and there was no report on 90-day mortality; TA was associated with significantly lower 28-day mortality [RR = 0.72, 95% CI (0.55, 0.93), P = 0.01; n = 494; GRADE rating: low], but there was no significant difference in the 90-day mortality [RR = 0.84, 95% CI (0.54, 1.31), P = 0.45; n = 91; GRADE rating: very low]. In the secondary outcome measures, there was obvious heterogeneity in the length of the ICU stay and that of the mechanical ventilation, length of the antibiotics and vasopressor use, and 28-day acute physiology and chronic health evaluation (APACHE) II scores. CONCLUSIONS: Treatment of severe @entity295 with @entity18274 reduced both the 28-day and the 90-day mortality, whereas treatment with TA reduced only the 28-day mortality. The effects of @entity18274 , UA, and TA on ICU stay, mechanical ventilation, antibiotics, and vasopressor use, and 28-day APACHE II scores of septic @entity1 are still unclear. Additional high quality RCTs are needed to define clearly the guidelines for the treatment of severe @entity295 . LEVEL OF EVIDENCE: Systematic review, level IV.
