Urinastatin combined with octreotide versus sole octreotide in severe acute pancreatitis: a meta-analysis

Background: For severe acute pancreatitis (SAP), the combination of urinastatin and octreotide (OCT) is increasingly used. This meta-analysis assesses whether the combination therapy of urinastatin and OCT is more effective than using sole OCT in treating SAP. Methods: After searching 12 databases in English and Chinese as well as two clinical trial centers up to October 7, 2023, we compared the combination of urinastatin and OCT with sole OCT in treating SAP. Statistical measures utilized include risk ratios (RR), weighted mean difference (WMD), and 95% confidence intervals (95% CI). Results: We summarized 145 studies from 145 hospitals in 26 provinces, municipalities, and autonomous regions of China, including 13,605 patients. It was found that for SAP, using urinastatin combined with OCT compared to using sole OCT can improve the total effective rate (I 2 = 0%; RR: 1.22; 95% CI: 1.19-1.24; P < 0.01), reduce mortality rate (I 2 = 0%; RR: 0.21; 95% CI: 0.09-0.46; P < 0.01), and reduce the overall incidence rate of complications (I 2 = 0%; RR: 0.28; 95% CI: 0.23-0.34; P < 0.01). In addition, combination therapy reduced in-hospital length of stay, abdominal pain relief time, time for blood and urine amylase to return to normal, inflammatory markers, and improved oxidative stress indicators, immune function indicators, and hemorheology indicators. Conclusions: Low-quality evidence suggests that for SAP, the combined use of urinastatin and OCT may be associated with better improvement in patients' symptoms, signs, CT imaging manifestations, and laboratory indicators such as inflammatory markers, oxidative stress markers, immune function indicators, and hemorheological indicators compared to using OCT alone. Additionally, the combination therapy compared to monotherapy may also be associated with lower mortality, a reduced incidence rate of complications, and a shorter in-hospital length of stay. Future research calls for multicenter, high-quality, well-designed studies to validate our findings.