Comparative efficacy and safety of Chinese botanical drug injection in patients with sepsis: A systematic review and Bayesian network meta-analysis of randomized clinical trials

Background: Sepsis represents a significant global health challenge, contributing to considerable morbidity, mortality, and healthcare costs. Integrating Chinese botanical drug injections (CBDIs) with Western Medical Treatments (WMT) has been increasingly recognized for its enhanced therapeutic effects in sepsis management. This Bayesian network meta-analysis aims to identify the optimal combination regimen of CBDIs and WMT for sepsis therapy. Methods: A comprehensive literature search was conducted across eight electronic databases to identify Randomized Controlled Trials (RCTs) relevant to our study criteria, spanning from their inception until January 1, 2024. The quality of included studies was rigorously assessed using the Cochrane Collaboration's Risk of Bias 2 (ROB 2) tool. Data synthesis and analysis were performed utilizing R 4.1.2 and Stata 17.0 software. Additionally, publication bias was assessed through the construction of funnel plots. Results: This network meta-analysis assessed 72 RCTs involving 6,351 participants to evaluate the effectiveness of seven CBDIs in conjunction with WMT. It found Huangqi injection to be the most effective in improving APACHE II scores. Tanreqing injections significantly reduced procalcitonin (PCT) levels, with particularly superior. Shenmai injection was most effective in decreasing C-reactive protein (CRP) levels. In terms of reducing tumor necrosis factor-alpha (TNF-α), Shenmai injection with WMT showed the best results. Xuebijing injection stood out in lowering white blood cell counts (WBC). Huangqi injection was noted for its best effectiveness in the 28-day mortality rates. Conclusion: The therapeutic efficacy of CBDIs in treating sepsis is underscored by our research findings, wherein certain botanical drugs exhibit heightened efficacy and safety attributes. The incorporation of these alternative modalities into contemporary sepsis management paradigms is advocated by the outcomes of our investigation. Nonetheless, rigorous, large-scale trials are imperative to substantiate and enhance these preliminary discoveries.