To evaluate the efficacy and safety of various immunomodulatory treatments for sepsis through a systematic review and network meta-analysis, addressing the gap in comparative studies.
Key Findings:
Ulinastatin significantly reduced all-cause mortality (RR 0.37, 95% CI 0.22-0.59).
Ulinastatin plus thymosin-α1, PUFA, and monoclonal antibody also lowered mortality compared to other treatments (RRs 0.65, 0.54-0.77; 0.74, 0.61-0.91; 0.92, 0.84-0.99).
Ulinastatin plus thymosin-α1 reduced ICU length of stay (MD −2.91, 95% CI −5.39 to −0.44).
PUFA shortened hospital length of stay (MD −20.55, 95% CI −39.81 to −0.51).
Ulinastatin (alone or with thymosin-α1) shortened mechanical ventilation duration (MDs −4.43, 95% CI −8.32 to −0.49; −1.86, 95% CI −3.14 to −0.41).
Interpretation:
Ulinastatin and its combinations show promise in reducing mortality and improving clinical outcomes in sepsis, but the low certainty of evidence highlights the need for further validation.
Limitations:
Most comparisons had low certainty of evidence, with potential biases including selection and reporting biases.
Need for large-scale, direct-comparison RCTs to validate findings.
Conclusion:
Ulinastatin, PUFA, and monoclonal antibodies have significant potential for improving outcomes in sepsis, warranting further research.
