Early prophylactic anticoagulation with heparin alleviates mortality in critically ill patients with sepsis: a retrospective analysis from the MIMIC-IV database

Zhi-ye Zou; Jia-jia Huang; Ying-yi Luan; Zhen-jia Yang; Zhi-peng Zhou; Jing-jing Zhang; Yong-ming Yao; Ming Wu

doi:10.1093/burnst/tkac029

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Early prophylactic anticoagulation with heparin alleviates mortality in critically ill patients with sepsis: a retrospective analysis from the MIMIC-IV database

更新时间：2023-09-05

- Early prophylactic anticoagulation with heparin alleviates mortality in critically ill patients with sepsis: a retrospective analysis from the MIMIC-IV database
- Early prophylactic anticoagulation with heparin alleviates mortality in critically ill patients with sepsis: a retrospective analysis from the MIMIC-IV database
- Burns & Trauma 2022年10卷第1期
- 作者机构：
  
  1. Department of Critical Care Medicine and Hospital Infection Prevention and Control, Shenzhen Second People’s Hospital & First Affiliated Hospital of Shenzhen University
  2. Postgraduate Education, Shantou University Medical College
  3. Capital Medical University
  4. Trauma Research Center, Medical Innovation Research Department and Fourth Medical Center of the Chinese PLA General Hospital
  5. Guangxi University of Chinese Medicine
- 作者简介：
- 基金信息：
  
  This work was supported by grants from the Sanming Project of Medicine in Shenzhen (SZSM20162011), The Project of Shenzhen Science and Technology Innovation Commission (JCYJ20190806163603504) and Shenzhen Second People’s Hospital Clinical Research Fund of Guangdong Province High-level Hospital Construction Project (20173357201815, 20193357003, 20203357014).
- DOI：10.1093/burnst/tkac029
  中图分类号：
- 纸质出版日期：2022，
  
  网络出版日期：2022-9-23，
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Early prophylactic anticoagulation with heparin alleviates mortality in critically ill patients with sepsis: a retrospective analysis from the MIMIC-IV database[J]. Burns & Trauma, 2022,10(1).

Zhi-ye Zou, Jia-jia Huang, Ying-yi Luan, Zhen-jia Yang, Zhi-peng Zhou, Jing-jing Zhang, Yong-ming Yao, Ming Wu, Early prophylactic anticoagulation with heparin alleviates mortality in critically ill patients with sepsis: a retrospective analysis from the MIMIC-IV database, Burns & Trauma, Volume 10, 2022, tkac029, https://doi.org/10.1093/burnst/tkac029
Early prophylactic anticoagulation with heparin alleviates mortality in critically ill patients with sepsis: a retrospective analysis from the MIMIC-IV database[J]. Burns & Trauma, 2022,10(1). DOI： 10.1093/burnst/tkac029.

Zhi-ye Zou, Jia-jia Huang, Ying-yi Luan, Zhen-jia Yang, Zhi-peng Zhou, Jing-jing Zhang, Yong-ming Yao, Ming Wu, Early prophylactic anticoagulation with heparin alleviates mortality in critically ill patients with sepsis: a retrospective analysis from the MIMIC-IV database, Burns & Trauma, Volume 10, 2022, tkac029, https://doi.org/10.1093/burnst/tkac029 DOI：

摘要

Abstract

BackgroundMinimal data exist on anticoagulation use and timing and the dose of heparin in patients with sepsis

and whether heparin use improves sepsis survival remains largely unclear. This study was performed to assess whether heparin administration would provide a survival advantage in critically ill patients with sepsis.MethodsA retrospective cohort study of patients with sepsis in the Medical Information Mart for Intensive Care (MIMIC)-IV database was conducted. Cox proportional hazards model and propensity score matching (PSM) were used to evaluate the outcomes of prophylactic anticoagulation with heparin administered by subcutaneous injection within 48 h of intensive care unit (ICU) admission. The primary outcome was in-hospital mortality. Secondary outcomes included 60-day mortality

length of ICU stay

length of hospital stay and incidence of acute kidney injury (AKI) on day 7. E-Value analysis were used for unmeasured confounding.ResultsA total of 6646 adult septic patients were included and divided into an early prophylactic heparin group (n = 3211) and a nonheparin group (n = 3435). In-hospital mortality in the heparin therapy group was significantly lower than that in the nonheparin group (prematched 14.7 vs 20.0%

hazard ratio (HR) 0.77

95% confidence interval (CI) [0.68–0.87]

p < 0.001

and postmatched 14.9 vs 18.3%

HR 0.78

95% CI [0.68–0.89]

p < 0.001). Secondary endpoints

including 60-day mortality and length of ICU stay

differed between the heparin and nonheparin groups (p < 0.01). Early prophylactic heparin administration was associated with in-hospital mortality among septic patients in different adjusted covariates (HR 0.71–0.78

p < 0.001)

and only administration of five doses of heparin was associated with decreased in-hospital mortality after PSM (HR 0.70

95% CI 0.56–0.87

p < 0.001). Subgroup analysis showed that heparin use was significantly associated with reduced in-hospital mortality in patients with sepsis-induced coagulopathy

septic shock

sequential organ failure assessment score ≥ 10

AKI

mechanical ventilation

gram-positive bacterial infection and gram-negative bacterial infection

with HRs of 0.74

0.70

0.58

0.74

0.73

0.64 and 0.72

respectively (p <0.001). E-Value analysis suggested robustness to unmeasured confounding.ConclusionsThis study found an association between early administration prophylactic heparin provided to patients with sepsis and reduced risk-adjusted mortality. A prospective randomized-controlled study should be designed to further assess the relevant findings.

关键词

Keywords

Early prophylactic anticoagulationHeparinMortalitySepsisCritically ill patients

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