Is ursodeoxycholic acid beneficial in critically ill patients with sepsis?

Critically ill patients with sepsis or septic shock who use ursodeoxycholic acid (UDCA) do not seem to experience improvement in shock severity and resolution, reveals a recent study. However, they have a higher chance of being extubated and not needing mechanical ventilation (MV) on the third day of admission to the intensive care unit (ICU).

In this retrospective study, the authors identified critically ill adult patients in the ICU admitted with sepsis/septic shock at King Abdulaziz Medical City in Riyadh, Saudi Arabia. They then categorized these patients into two groups based on their UDCA usage. After matching, based on severity of illness scores within 24 hours of admission, 88 patients were included in the final analysis.

The effect of UDCA on the severity and resolution of shock at day 3 of ICU admission was the primary outcome. Secondary outcomes included 30-day in-hospital mortality, MV duration, and ICU length of stay (LOS).

Eighty-eight patients were matched, of which 44 (50 percent) received UDCA during the study period. At day 3, use of UDCA was not associated with improvement in Sequential Organ Failure Assessment score (p=0.32), inotropes/vasopressors requirement (p=0.79), Glasgow Coma Scale (p=0.59), or total bilirubin levels (p=0.79) compared with controls.

However, UDCA use was significantly associated with improvement in PaO₂/FiO₂ ratio (p=0.01) and early extubation at day 3 (p=0.04).

“Using UDCA in critically ill patients as adjunctive therapy for sepsis/septic shock in neonates and children is controversial, while it has not been extensively investigated in adults,” the authors said.