Ulinastatin Protects Cognition in Cardiac Surgical Patients

This study aimed to investigate the incidence of postoperative cognitive dysfunction (POCD) in patients undergoing cardiac valve surgery and the potential protective effects of ulinastatin on POCD.

This was a prospective, multicenter, randomized, double-blind clinical trial. A total of 300 patients undergoing cardiac valve surgery were enrolled across the 3 hospitals and randomized to the control or ulinastatin treatment groups. The patients' cognition was evaluated using the Mini-Mental State Examination (MMSE). POCD was defined as a lower cognitive score after surgery than the baseline score. Serum levels of proinflammatory cytokines were measured by an enzyme-linked immunosorbent assay.

The incidence of POCD in the control group was significantly higher than those in the ulinastatin group (42/150 vs. 24/150, p <0.05). The MMSE score in the control group was significantly lower after the operation [D0 vs. D3: 27.72 (1.88) vs. 27.09 (2.61), p <0.05], but did not change in the ulinastatin group [D0 vs. D3: 27.63 (2.29) vs. 27.31 (2.47), p >0.05]. In the ulinastatin group, plasma levels of matrix metallopeptidase 9 (MMP9) and S100 calcium-binding protein B (S100β) were significantly lower than those in the control group after the operation.

The present study confirms that a transient proinflammatory state impairs cognition in patients undergoing cardiac surgery and indicates that perioperative administration of ulinastatin protects cognition.