Ulinastatin Protects Cognition in Cardiac Surgical Patients.
[NOTABLE] Hemoadsorption during endocarditis surgery produced the largest mortality signal in today's literature, and the design cannot support it.
In 176 high-risk IE patients across 2020-2024 , the hemoadsorption group had less vasoplegia (24.7% vs 49.4%), shorter ICU stay (7.8 vs 11.5 days), and 30-day mortality of 7.5% versus 20.5%, with a win ratio of 3.83.
PURPOSE: 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. METHODS: 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. RESULTS: 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]. 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. CONCLUSIONS: 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.
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