Ulinastatin reduces elevation of cytokines and soluble adhesion molecules during cardiac surgery

Purpose: To investigate whether ulinastatin pretreatment (6000 U . kg(-1) before CPB and before declamping of aorta) influenced the production of cytokines and adhesion molecules in the peripheral circulation. Methods: This prospective randomized study was performed in 22 patients undergoing cardiac surgery. They were divided into two groups. Patients in Group I were untreated and in Group II treated with ulinastatin. The soluble intercellular adhesion molecule-1 (S-ICAM-1), interleukin8 and 6 (IL-8, 6 were measured using ELISA kits. Results: Serum S-ICAM-I concentration in Group I increased from the preoperative value of 297 +/- 27 ng . kg(-1) to 418 +/- 106 ng . kg(-1) at 60 min after declamping of aorta (P < 0.01) but did not change in Group II. Serum S-ELAM-1 concentration did not change in either group. Serum concentration of IL-8 and IL-6 in Group I (37 +/- 44 pg . kg(-1), and 59 +/- 59 pg . kg(-1), preoperatively) increased to 169 +/- 86 pg . kg(-1) and 436 +/- 143 pg . kg(-1) at 60 min after declamping of the aorta (P < 0.001, P < 0.001). The increases were greater than those from 25 +/- 6 pg . kg(-1) and 30 +/- 26 pg . kg(-1) to 56 +/- 36 pg . kg(-1) and 132 +/- 78 pg . kg(-1) in Group II (P < 0.001, P < 0.001). The levels of S-ICAM-1 correlated with those of IL-8 (r = 0.5, P < 0.001).