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      Efficacy of Xuebijing Injection for Sepsis (EXIT-SEP): protocol for a randomised controlled trial

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          Abstract

          Introduction

          Sepsis is a major challenge with high incidence and is associated with high mortality worldwide. Current management of sepsis remains mainly supportive except for treatment with antibiotics. Both basic research and clinical investigation have shown that the Chinese herbal-derived therapeutic Xuebijing (XBJ) injection is beneficial for patients with sepsis. However, the quality of evidence supporting the therapeutic use of XBJ in sepsis is limited. The aim of this trial is to evaluate the Efficacy of Xuebijing Injection for Sepsis, compared with a placebo, on the outcome of patients with sepsis in the intensive care unit (ICU).

          Methods and analysis

          In this multicentre, blinded randomised controlled trial, we are recruiting a total of 1800 subjects who met Sepsis 3.0 criteria. Subjects will be randomised (1:1) to receive XBJ, every 12 hours for 5 days or a matching placebo and usual care. The primary outcome is 28 days all-cause mortality. Secondary outcomes will be the improvement of Sequential Organ Failure Assessment scores, the improvement of the Acute Physiology and Chronic Health Evaluation II score, duration of mechanical ventilation, mortality in ICU and duration of stay in the ICU. Investigators, participants and statisticians will be blinded to the allocated treatment.

          Ethics and dissemination

          This trial has been approved by all ethics committees of the centres that will participate in this trial. The findings of the study will be disseminated in peer-reviewed journals and present at conferences. Once this study is complete, the results of this trial may help provide evidence-based recommendations for complementary therapeutic options for patients with sepsis.

          Trial registration number

          NCT03238742 and ChiCTR-IPR-17012713.

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          Most cited references9

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          Systematic review and meta-analysis of the efficacy of appropriate empiric antibiotic therapy for sepsis.

          Quantifying the benefit of early antibiotic treatment is crucial for decision making and can be assessed only in observational studies. We performed a systematic review of prospective studies reporting the effect of appropriate empirical antibiotic treatment on all-cause mortality among adult inpatients with sepsis. Two reviewers independently extracted data. Risk of bias was assessed using the Newcastle-Ottawa score. We calculated unadjusted odds ratios (ORs) with 95% confidence intervals for each study and extracted adjusted ORs, with variance, methods, and covariates being used for adjustment. ORs were pooled using random-effects meta-analysis. We examined the effects of methodological and clinical confounders on results through subgroup analysis or mixed-effect meta-regression. Seventy studies were included, of which 48 provided an adjusted OR for inappropriate empirical antibiotic treatment. Inappropriate empirical antibiotic treatment was associated with significantly higher mortality in the unadjusted and adjusted comparisons, with considerable heterogeneity occurring in both analyses (I(2) > 70%). Study design, time of mortality assessment, the reporting methods of the multivariable models, and the covariates used for adjustment were significantly associated with effect size. Septic shock was the only clinical variable significantly affecting results (it was associated with higher ORs). Studies adjusting for background conditions and sepsis severity reported a pooled adjusted OR of 1.60 (95% confidence interval = 1.37 to 1.86; 26 studies; number needed to treat to prevent one fatal outcome, 10 patients [95% confidence interval = 8 to 15]; I(2) = 46.3%) given 34% mortality with inappropriate empirical treatment. Appropriate empirical antibiotic treatment is associated with a significant reduction in all-cause mortality. However, the methods used in the observational studies significantly affect the effect size reported. Methods of observational studies assessing the effects of antibiotic treatment should be improved and standardized.
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            Sepsis: pathophysiology and clinical management

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              Xuebijing in the treatment of patients with sepsis.

              There are more than 18 million patients diagnosed with sepsis every year. In China, Xuebijing (XBJ) injection is a traditional medicine that is widely used in the treatment of sepsis. However, the efficacy of XBJ in treatment of randomized controlled trials (RCTs) remains unclear. This meta-analysis was to evaluate the clinical efficacy of XBJ based on randomized case-control studies.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2019
                28 August 2019
                : 9
                : 8
                : e028664
                Affiliations
                [1 ] departmentDepartment of Critical Care Medicine, School of Medicine , Zhongda Hospital, Southeast University , Nanjing, China
                [2 ] departmentMedical Statistics Office , Peking University First Hospital , Beijing, China
                [3 ] departmentEvidence-Based Medicine , Tianjin University of Traditional Chinese Medicine , Tianjin, China
                Author notes
                [Correspondence to ] Dr Haibo Qiu; haiboq2000@ 123456163.com
                Author information
                http://orcid.org/0000-0002-1875-1131
                Article
                bmjopen-2018-028664
                10.1136/bmjopen-2018-028664
                6720249
                31467049
                0c13ca12-1410-4a83-98d9-bf97a2600e1a
                © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 28 December 2018
                : 17 July 2019
                : 25 July 2019
                Funding
                Funded by: Development Center for Medical Science and Technology, National Health and Family Planning Commission of the People’s Republic of China;
                Award ID: WK-2016-HR-03
                Categories
                Intensive Care
                Protocol
                1506
                1707
                Custom metadata
                unlocked

                Medicine
                xuebijing injection,sepsis,randomised controlled trial,protocol
                Medicine
                xuebijing injection, sepsis, randomised controlled trial, protocol

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