[Amelioration of inflammatory reaction in patients with severe sepsis with inosine]

To evaluate the therapeutic effect of inosine in patients with severe sepsis.

A prospective study was conducted. Eighty-five severe sepsis patients hospitalized in intensive care unit (ICU) from March 2011 to August 2012 were included and randomized into three groups: 25 cases as conventional therapy group, who were treated with routine treatments; 28 patients were given inosine within 6 hours besides routine treatments; 32 patients were given inosine after 6 hours together with routine treatments. Inosine was given in the latter two groups by intravenous infusion (600 mg twice a day) for 10-14 days or to the end of the research when patients died or discharged from ICU. Before or after the treatment, venous blood was collected for determination of pro-inflammatory factors and organ function parameters. Average duration of stay in ICU and mortality rate were analyzed.

Compared with conventional therapy group, the levels of pro-inflammatory factors, such as tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and C-reactive protein (CRP) were decreased in inosine in both within 6-hour and after 6-hour groups (TNF-α: 9.6 ± 4.1 ng/L, 10.8 ± 2.8 ng/L vs. 18.2 ± 3.3 ng/L, IL-6: 123.0 ± 10.1 ng/L, 132.0 ± 18.4 ng/L vs. 172.0 ± 17.9 ng/L, CRP: 42.0 ± 10.3 mg/L, 45.0 ± 8.6 mg/L vs. 61.0 ± 12.7 mg/L, all P<0.05), but there was no statistical significance in the content of IL-10 (53.0 ± 9.4 ng/L, 56.0 ± 10.8 ng/L vs. 58.0 ± 11.2 ng/L, both P>0.05). The lowering of alanine transaminase (ALT), total bilirubin, B-type natriuretic peptide (BNP), oxygenation index was more marked in inosine within 6-hour and after 6-hour groups than those of conventional therapy group (ALT: 42.0 ± 10.8 U/L, 46.0 ± 7.9 U/L vs. 63.0 ± 9.4 U/L, total bilirubin: 16.3 ± 6.7 μmol/L, 18.3 ± 7.3 μmol/L vs. 28.1 ± 8.5 μmol/L, BNP: 322.0 ± 28.7 ng/L, 347.0 ± 31.4 ng/L vs. 428.0 ± 43.2 ng/L, oxygenation index: 210.0 ± 23.8 mm Hg, 198.0 ± 21.4 mm Hg vs. 163.0 ± 15.2 mm Hg, all P<0.05). However, the difference of these values showed no significant difference between the two inosine groups (all P>0.05). There was no statistical significance in ICU stay days (22.4 ± 6.3 days, 19.8 ± 4.6 days, 23.1 ± 5.2 days) and mortality rate (36.0%, 32.1%, 34.4%) among three groups (all P>0.05).

For severe sepsis patients, on the base of routine treatments, normal dose of inosine can lower the level of pro-inflammatory factors and ameliorate organ function, but it cannot decrease average ICU stay days and mortality rate.