Ulinastatin Add-on to Standard of Care in Critically Ill COVID-19 Patients: A Multicenter, Retrospective Study

Area of Science:

• Critical Care Medicine
• Pharmacology
• Infectious Diseases

Background:

• Coronavirus disease (COVID-19) poses significant challenges in intensive care units (ICUs).
• Limited therapeutic options exist for severe COVID-19 cases requiring ICU admission.
• Ulinastatin (ULI) is a protease inhibitor with potential anti-inflammatory properties.

Purpose of the Study:

• To evaluate the impact of ulinastatin (ULI) as an add-on therapy to standard of care (SOC) on 30-day mortality in ICU patients with COVID-19.
• To compare outcomes between patients receiving SOC alone versus ULI plus SOC.

Main Methods:

• A multicentric, retrospective study involving 94 COVID-19 patients admitted to the ICU.
• Comparison of 30-day mortality between patients treated with SOC alone and those receiving ULI as add-on to SOC.
• Odds ratios (OR) and 95% confidence intervals (CI) were calculated to identify mortality predictors.

Main Results:

• Univariate analysis showed significantly lower 30-day mortality in the ULI plus SOC group (36.2%) compared to SOC alone (51.1%).
• The beneficial effect of ULI was more pronounced in non-intubated patients and with early ULI administration (within 72 hours).
• Multivariate analysis indicated intubation as the sole predictor of mortality, with ULI's effect on survival becoming non-significant.

Conclusions:

• Early administration of ulinastatin (ULI) may improve outcomes in COVID-19 ICU patients, especially those not requiring intubation.
• The findings suggest ULI could be a potentially helpful therapeutic option given limited treatment choices.
• A large, randomized controlled trial is recommended to validate these preliminary findings and confirm ULI's efficacy in COVID-19 patients.