Efficacy of sivelestat sodium in acute respiratory distress syndrome in adults:a systematic review and meta-analysis
Objective To systematically evaluate the clinical efficacy of sivelestat sodium in the treatment of adult patients with acute respiratory distress syndrome(ARDS).Methods A comprehensive search of PubMed,Embase,the Cochrane Library,CNKI,SinoMed,and Wanfang Databases were conducted to gather RCTs and cohort studies of sivelestat sodium in the treatment of adult ARDS from the inception of the databases to May 31,2023.Data were extracted from the literature that met the inclusion and exclusion criteria.The risk of bias in RCTs(RoB 2.0)and risk of bias in non-randomized studies of intervention(ROBINS-I)were employed to assess the quality of the studies.RevMan 5.4 and Stata 17.0 software were utilized for meta-analysis.Results A total of 16 studies involving 9202 patients were included,including 7 RCTs and 9 cohort studies.Meta-analysis revealed that sivelestat sodium had no impact on 28-day or 30-days mortality of ARDS patients in RCTs study(RR=0.95,95％CI:0.74 to 1.21,P=0.68),but in the cohort study,sivelestat sodium treatment could decrease the 28～30 d mortality of ARDS patients(RR=0.86,95％CI:0.81 to 0.92,P<0.0001).Sivelestat sodium treatment could significantly enhance the oxygenation index in ARDS patients(in RCTs study,MD=33.08,95％CI:15.43 to 50.74,P<0.000 01;in cohort study,MD=39.74,95％CI:29.81 to 49.68,P<0.000 01).Sivelestat sodium treatment could abbreviate the duration of mechanical ventilation in patients with mild to moderate ARDS(MD=-2.48,95％CI:-2.91 to-2.05,P<0.000 01).Egger's test showed that there was no publication bias in the included studies(P<0.05).Conclusion Sivelestat sodium can improve oxygenation index and shorten the duration of mechanical ventilation in patients with mild-to-moderate ARDS.The effect of sivelestat sodium on 28-day or 30-day mortality needs further study to verify.
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