Evaluation of therapeutic effectiveness of ulinastatin in acute pancreatitis

Abstract

Introduction: Acute pancreatitis is an inflammatory condition of the pancreas which begins in pancreatic acinar cells and triggers local inflammation that may progress to systemic inflammatory response (SIRS) and causing distant organ involvement and its function and ending up with multiple organ dysfunction syndromes (MODS). Aim: To find out the effectiveness of addition of Ulinastatin to standard care in Indian subjects with acute pancreatitis. Methodology: A concurrent observational study is done to evaluate the effect of addition of Ulinastatin to the standard treatment and its efficacy to reduce the serum amylase and lipase levels in patients with Acute Pancreatitis. patients of both the genders i.e. male and female. Results: In the control groups 43 were males and 57 were females. In the test group 47 were males and 53 females. Majority were in the age group between 30- 70 yrs of age with >50% in the 30-50 yrs age group in both tests and control group. Serum amylase the mean S.amylase: levels in control group was 686.16 units/l (day1), 515.72U/l (day2), 400.27 U/l (day 3), 296.42 U/l (day 4). whereas in the test group the mean amylase levels were 687.14 u/l (day 1), 233.83 u/l (day 2), 103.58 u/l (day3), 67.14 u/l (day 4) suggesting that after 5 days of therapy the amylase levels in the test groups touched normal values whereas in the control groups they were still high (>3 times) the normal (n-60 units/1l). The mean serum lipase levels in the control group at day 1 was 224.8 u/l, 142.93 u/l (day 2), 111.34 u/l (day3) and 82.78 u/l (day4).Where as in a test group the mean serum lipase level was 380.42 u/l (day1), 191.92 u/l (day 2), 91.58 u/l (day 3), 31u/l (day 4). The difference in the mean values between the control and test group for both serum amylase and serum lipase levels were found to be statistically very significant. On follow up after 5 days for a period of 2 weeks none of the patients in the test group developed any complication. Where as in the control group 12 patients developed pleural effusion, 8-Pseudopancreatic cyst, 7- developed pancreatic pleural fistula which were treated symptomatically whereas in test group one patient developed pleural effusion and another pancreatic fistula symptomatically treated. Conclusion: The study concluded that addition of Ulinastatin to standard treatment of acute Pancreatitis is effective in reducing morbidity and mortality in Indian subjects.