Related Experiment Videos

Association of ulinastatin with 28-day mortality across different severities of viral pneumonia: a multicenter

Yu Zhang1, Zongmian Zhang2, Yunhai Zhang3

  • 1Department of Critical Care Medicine, The First People's Hospital of Foshan (The Affiliated Foshan Hospital of Southern University of Science and Technology), School of Medicine, Southern University of Science and Technology, Foshan, Guangdong, China.

Frontiers in Pharmacology
|July 15, 2026
PubMed
Abstract

Insights

Ulinastatin did not significantly reduce mortality in severe or critical viral pneumonia. However, it showed a survival benefit in critically ill patients, particularly those with COVID-19.

Area of Science:

  • Critical care medicine
  • Immunology
  • Infectious diseases

Background:

  • Hyperinflammation is a key driver of mortality in severe and critical viral pneumonia.
  • Ulinastatin is an immunomodulatory agent with potential therapeutic applications.

Purpose of the Study:

  • To evaluate the association of ulinastatin with 28-day mortality in patients with severe or critical pneumonia caused by COVID-19 or influenza.
  • To explore potential survival benefits in specific patient subgroups.

Main Methods:

  • Multicenter, retrospective cohort study.
  • Inclusion of adult patients in the intensive care unit (ICU) with confirmed SARS-CoV-2 or influenza.
  • 1:1 propensity score matching (PSM) to control for confounding factors.

Main Results:

  • Ulinastatin treatment did not significantly reduce 28-day all-cause mortality in the overall matched cohort (29.9% vs. 38.1%).
  • Exploratory subgroup analysis revealed a significant survival benefit in critically ill patients (HR 0.51, p = 0.011), but not in severe patients.
  • The survival benefit in critical patients was consistent across COVID-19 and influenza and was not significantly modified by comorbidities.

Conclusions:

  • Ulinastatin did not significantly improve survival in the overall cohort of severe-to-critical viral pneumonia.
  • A potential survival benefit was observed in critically ill patients, predominantly in the COVID-19 subset.
  • Further research is needed to confirm these hypothesis-generating findings and explore precision immunomodulation strategies.
Keywords:
COVID-19critical illnessinfluenzamortalityobservational studyulinastatin

Related Concept Videos

Pneumonia V: Nursing management and Prevention01:30

Pneumonia V: Nursing management and Prevention

Nursing management of pneumonia involves promoting airway patency, facilitating rest and conserving energy, encouraging fluid intake, maintaining nutrition, and educating patients.
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed.
Pneumonia III: Complications and Assessment01:30

Pneumonia III: Complications and Assessment

Pneumonia poses the potential for numerous complications that warrant consideration. These complications include the following:
Pneumonia IV: Management01:28

Pneumonia IV: Management

The treatment of pneumonia varies based on its severity and the causative pathogen. Here is a structured approach to managing pneumonia, integrating pharmaceutical and supportive care strategies.
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
Pneumonia II: Pathophysiology01:29

Pneumonia II: Pathophysiology

The pathophysiology of pneumonia involves the following steps:
Acute Respiratory Failure-II01:21

Acute Respiratory Failure-II

Type I Respiratory Failure, or hypoxemic respiratory failure, occurs when the partial pressure of oxygen (PaO2) in arterial blood falls below 60 mmHg while breathing room air without a corresponding increase in arterial carbon dioxide levels (PaCO2). This condition highlights a significant impairment in the lungs' capacity to oxygenate the blood.
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
Pneumonia I: Introduction01:29

Pneumonia I: Introduction

Pneumonia is an infection of the lower respiratory tract that leads to inflammation of the lung parenchyma, often resulting in the accumulation of inflammatory exudate in the alveoli and airways. Unlike the watery, low-protein fluid exudate in pulmonary edema, the exudate in this case is a thick fluid rich in immune cells, proteins, and debris produced during infection and inflammation.This impairs gas exchange and can lead to consolidation of lung tissue. The infection may be caused by a...