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Burns is a global health problem with significant morbidity and mortality. Ulinastatin, a serine protease inhibitor, has the potential to improve outcomes in burns. A retrospective comparative case note review analysis was performed to assess the impact of ulinastatin on the outcomes in acute burns patients. Acute burns patients, admitted to Masina hospital, Mumbai, from October 2012 to April 2015, who received ulinastatin, were identified from the hospital records. A similarly sized cohort of patients, admitted before the introduction of ulinastatin, was also identified. Relevant data were obtained from archived patient files. The outcomes, mortality and length of hospital stay, were compared across different groups and subgroups. Data of 97 patients, 48 of whom received ulinastatin (ulinastatin group) and 49 of whom did not (control group), were captured. Patients in ulinastatin group had received ulinastatin 100,000 IU, 8 to 12 hourly, during a mean period of 8.8 days, based on clinical judgment, in addition to standard hospital care. The in-hospital mortality was lower (60.4%) in ulinastatin group compared with control group (75.5%). The difference in mortality was statistically significant (50% vs 77.27%; P = .04) in those with 41 to 80% burnt BSA. Mean length of hospital stay, where shorter duration of hospitalization is usually associated with death, was higher in ulinastatin group compared with the control group. Ulinastatin appears to reduce mortality in acute burns patients, especially in those with intermediate extent (40 to 80%) of burnt BSA. It also appears to delay death in those who ultimately succumbed to their burn injuries.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.