Efficacy of combined use of Xuebijing and ulinastatin for paraquat poisoning: A systematic review and meta-analysis of randomized controlled trials

Abstract Background: There are no clinically effective antidotes for paraquat poisoning, which progresses rapidly with a poor prognosis and high mortality. The addition of Xuebijing (XBJ) and ulinastatin (UTI) combination to conventional therapy has been reported as a novel treatment approach.Objective: To compare the effectiveness of Xuebijing combined with ulinastatin and conventional treatment group in the treatment of paraquat poisoning.Methods: The CNKI, VIP, WanFang, PubMed, EMBASE, and MEDLINE databases were searched for publications on randomized controlled clinical trials that compared the XBJ+UTI combination as an additional treatment to conventional therapy versus conventional therapy alone.Results: Quality assessment of the selected publications was performed and data were extracted for analysis. The final analysis included five publications, reporting 588 patients with paraquat poisoning. The control and XBJ+UTI groups comprised 294 patients each; 138 and 100 patients in the control and conventional therapy plus XBJ+UTI groups died, respectively. The combined analysis showed that the mortality relative risk (RR) was 0.72 and I2 was 46.2%. Three publications reported of pulmonary fibrosis (PF) and multiple organ dysfunction syndrome (MODS), in which 134 patients were included in each of the control and XBJ+UTI groups. MODS occurred in 117 and 88 patients in the control and conventional therapy plus XBJ+UTI groups, respectively. The combined analysis using the random-effects model showed that the RR was 0.75 and I2 was 0.0%. PF occurred in 99 and 68 patients in the control and conventional therapy plus XBJ+UTI groups, respectively. The combined analysis using the random-effects model showed that the RR was 0.69 and I2 was 0.0%.Conclusions: We preliminarily demonstrated that compared with those of conventional therapy alone, the addition of XBJ+UTI combination for the treatment of paraquat poisoning could reduce the mortality rate and incidence of MODS and PF.