Systematic review and meta-analysis of the efficacy of trypsin inhibitors in patients with severe pancreatitis.

Jin Zhang, Li Niu, Yunfeng Yang, Yuxia Hao, Jing Feng

Annals of palliative medicine 2021 Jun

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This study aimed to explore the efficacy of trypsin inhibitors in the treatment of severe pancreatitis (SP) by meta-analysis. The Boolean logic retrieval method was adopted to recruit the relevant literature. Chinese and English databases were respectively searched using a combination of the following search terms: "trypsin inhibitor", "acute pancreatitis", and "severe pancreatitis". The trypsin-treated SP group was set as the experimental group, and the blank control was set as the control group. Meta-analysis was performed using RevMan 5.3 software provided by the Cochrane system. A total of 12 references were included. The meta-analysis suggested that the heterogeneity test results of pancreatic infection incidence were Chi2 =0.51, degrees of freedom (df) =7, I2=0%<50%, and P=1.00>0.01, with risk ratio (RR): 0.80, 95% confidence interval (CI): (0.64, 1.01), Z=1.88, and P=0.06. The heterogeneity test results of extra-pancreatic infection incidence were Chi2 =0.20, df =5, I2=0%<50%, and P=1.00>0.01, with RR: 0.81, 95% CI: (0.62, 1.05), Z=1.60, and P=0.11. The heterogeneity test results of the length of hospital stay were Tau2 =65.69, Chi2 =75.05, df =6, I2=92%>50%, and P<0.0001. The length of hospital stay of the experimental group was shorter than that of the control group, with mean difference (MD): -23.31 and the 95% CI: (-29.60, -17.02), and the difference was statistically significant (Z=7.26, P<0.0001). The heterogeneity test results of the inflammatory factor tumor necrosis factor-α (TNF-α) level were Chi2 =67.28, df =3, I2=96%>50%, and P<0.0001. The level of TNF-α in the experimental group was lower than that in the control group, with MD: -11.69, 95% CI: (-12.51, -10.87), and the difference was statistically significant (Z=27.88, P<0.0001). The heterogeneity test results of the mortality rate were Chi2 =2.52, df =5, I2=0%<50%, and P=0.77>0.01. The mortality rate of the experimental group was lower than that of the control group, with RR: 0.27 and 95% CI: (0.19, 0.40), and the difference was notable (Z=6.75, P<0.0001). The meta-analysis performed in this study confirmed that trypsin inhibitors can inhibit the release of inflammatory factors and reduce mortality rate of SP patients.

Citation

Jin Zhang, Li Niu, Yunfeng Yang, Yuxia Hao, Jing Feng. Systematic review and meta-analysis of the efficacy of trypsin inhibitors in patients with severe pancreatitis. Annals of palliative medicine. 2021 Jun;10(6):6577-6587