Clinical efficacy of ulinastatin in patients with pulmonary edema: A systematic review and meta-analysis of randomized controlled trials

Objective:To methodically assess the clinical impact of ulinastatin on patients suffering from pulmonary edema.Methods:PubMed, Web of Science, Cochrane Library, Embase, Chinese National Knowledge Infrastructure (CNKI), Wanfang data, Chinese Scientific Journal Database (VIP), and Chinese Biomedical Literature Database (CBM) databases were searched using such keywords as ulinastatin, pulmonary edema, and randomized controlled trial (RCT). The search time was from the establishment of the database to August 2023. Two researchers were responsible for literature screening and data collection respectively. After the risk of bias in the included studies was evaluated, meta-analysis was performed using statistical software RevMan 5.4 and GRADE profiler software was used to evaluate evidence quality.Results:Nine RCTs were included in the meta-analysis. Meta-analysis results showed that compared with conventional treatment group, the incidence of pulmonary edema of the patients in the ulinastatin group decreased, with odds ratios (OR) of 0.36 (95% CI: 0.20, 0.657), extravascular pulmonary water index (EVLWI) decreased, with mean difference (MD) of -0.75 (95% CI: -1.32, -0.17), ventilator use time decreased, with MD of -2.86 (95% CI: -0.26, 0.23), the intensive care unit (ICU) length of stay decreased, with MD of -1.56 (95% CI: -1.75, -1.38). The pulmonary vascular permeability index (PVPI) decreased in ulinastatin group, with MD of -0.10 (95% CI: -0.24, 0.03), but the difference was not statistically significant.Conclusion:Compared with conventional treatment, ulinastatin may reduce the incidence of pulmonary edema, decrease EVLWI, ventilator use time and the ICU length of stay in patients with pulmonary edema, but it could not reduce PVPI.