요 트립신 억제제가 패혈증 환자의 예후에 미치는 영향

Abstract

Purpose: We purposed to determine the effects of urinary typsin inhibitor (ulinastatin) on the outcomes of severe sepsis and septic shock patients. Methods: This is a prospective case control study of severe sepsis and septic shock patients who visited emergency department of university hospital from January 2005 to June 2008. For study group, 100,000 U of ulinastatin was initially infused and then additional infusions of ulinastatin were determined by the mean arterial pressure. We compared the predicted mortality and the actual in-hospital mortality between the ulinastatin group and the control group. We also compared the improvement of the SOFA score according to time between the groups. Results: There were 43 patients in the ulinastatin group and 126 patients in the control group. The predicted mortality and the actual mortality of the ulinastatin group were 31.2% and 18.6%, respectively. The predicted and actual mortalities of the control group were 33.1% and 27.0%, respectively. The improvement of the SOFA score for the ulinastatin group was 6.8±3.9 and 5.0±4.5 at 0 and 24 hours (p<0.001), 6.5±3.7 and 3.9±4.3 at 0 and 48 hours (p<0.001) and, 6.3±3.6 and 3.0±4.1 at 0 and 72 hours (p<0.001). For the control group, the change of the SOFA score was 4.9±2.9 and 5.8±4.1 at 0 and 24 hours (p=0.003), 5.0±2.8 and 5.1±4.2 at 0 and 48 hours (p=0.760) and, 4.8±2.7 and 4.3±4.1 at 0 and 72 hours (p=0.105). Conclusion: The ulinastatin group showed significantly lower mortality than the predicted mortality and the ulinastatin group’s SOFA score was improved in the early hospital days.