PMID- 37256226 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230601 IS - 1663-9812 (Print) IS - 1663-9812 (Electronic) IS - 1663-9812 (Linking) VI - 14 DP - 2023 TI - Effectiveness of early heparin therapy on outcomes in critically ill patients with sepsis-induced coagulopathy. PG - 1173893 LID - 10.3389/fphar.2023.1173893 [doi] LID - 1173893 AB - Background: This study aimed to investigate whether early unfractionated heparin (UFH) administration provides a survival advantage for patients with sepsis-induced coagulopathy (SIC). Methods: Patients hospitalized with sepsis-induced coagulopathy from the Medical Information Mart for Intensive Care (MIMIC)-IV database were identified. Patients were divided into two groups, who received unfractionated heparin (UFH) subcutaneously within 24 h after intensive care unit (ICU) admission, and the control group, who received not. The primary endpoint was intensive care unit mortality, the secondary outcomes were 7, 14, and 28-day and hospital mortality. Propensity score matching (PSM) the marginal structural Cox model (MSCM) and E-value analysis were used to account for baseline differences, time-varying and unmeasured confounding factors. Results: A total of 3,377 patients with sepsis-induced coagulopathy were enrolled in the study, of which 815 in unfractionated heparin group and 2,562 in control group. There was significant effect on primary and secondary outcomes with unfractionated heparin after propensity score matching (intensive care unit mortality, hazard ratio [HR] 0.69, 95% confidence interval [CI] 0.52-0.92; 7-day, HR 0.70, 95% CI 0.49-0.99; 14-day, HR 0.68.95% CI 0.50-0.92; 28-day, HR 0.72, 95% CI 0.54-0.96; hospital mortality, HR 0.74, 95% CI 0.57-0.96), marginal structural Cox model manifested unfractionated heparin associated with decreased intensive care unit mortality in all populations (HR 0.64, 95% CI 0.49-0.84), and stratification with the marginal structural Cox model indicated analysis further indicated the survival advantage only among patients with an sepsis-induced coagulopathy score of 4 (HR 0.56, 95% CI 0.38-0.81). Further analysis showed that treatment with 6,250-13750 IU/day of unfractionated heparin associated with a decreased risk of intensive care unit mortality. Similar results were replicated in subgroup analysis with propensity score matching only for patients with an sepsis-induced coagulopathy score of 4 (intensive care unit mortality, HR 0.51, 95% CI 0.34-0.76). Conclusion: This study found early unfractionated heparin therapy to patients with sepsis-induced coagulopathy appears to be associated with improved outcomes. Subgroup analysis further demonstrates heparin therapy decreased intensive care unit mortality primarily in patients only with SIC score of 4. CI - Copyright (c) 2023 Huang, Zou, Zhou, Liu, Yang, Zhang, Luan, Yao and Wu. FAU - Huang, Jia-Jia AU - Huang JJ AD - Department of Infection and Critical Care Medicine, Health Science Center, Shenzhen Second People's Hospital and First Affiliated Hospital of Shenzhen University, Shenzhen, China. AD - Postgraduate Education, Shantou University Medical College, Shantou, China. FAU - Zou, Zhi-Ye AU - Zou ZY AD - Department of Infection and Critical Care Medicine, Health Science Center, Shenzhen Second People's Hospital and First Affiliated Hospital of Shenzhen University, Shenzhen, China. FAU - Zhou, Zhi-Peng AU - Zhou ZP AD - Department of Infection and Critical Care Medicine, Health Science Center, Shenzhen Second People's Hospital and First Affiliated Hospital of Shenzhen University, Shenzhen, China. FAU - Liu, Yan AU - Liu Y AD - Department of Infection and Critical Care Medicine, Health Science Center, Shenzhen Second People's Hospital and First Affiliated Hospital of Shenzhen University, Shenzhen, China. FAU - Yang, Zhen-Jia AU - Yang ZJ AD - Department of Infection and Critical Care Medicine, Health Science Center, Shenzhen Second People's Hospital and First Affiliated Hospital of Shenzhen University, Shenzhen, China. AD - Postgraduate Education, Shantou University Medical College, Shantou, China. FAU - Zhang, Jing-Jing AU - Zhang JJ AD - Department of Infection and Critical Care Medicine, Health Science Center, Shenzhen Second People's Hospital and First Affiliated Hospital of Shenzhen University, Shenzhen, China. AD - Department of Critical Care Medicine, Pingshan District People's Hospital of Shenzhen, Shenzhen, China. FAU - Luan, Ying-Yi AU - Luan YY AD - Department of Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China. FAU - Yao, Yong-Ming AU - Yao YM AD - Trauma Research Center, Medical Innovation Research Department and Fourth Medical Center of the Chinese PLA General Hospital, Beijing, China. FAU - Wu, Ming AU - Wu M AD - Department of Infection and Critical Care Medicine, Health Science Center, Shenzhen Second People's Hospital and First Affiliated Hospital of Shenzhen University, Shenzhen, China. AD - Postgraduate Education, Shantou University Medical College, Shantou, China. AD - Department of Nosocomial Infection Prevention and Control, Shenzhen Second People's Hospital, Shenzhen, China. LA - eng PT - Journal Article DEP - 20230515 PL - Switzerland TA - Front Pharmacol JT - Frontiers in pharmacology JID - 101548923 PMC - PMC10225678 OTO - NOTNLM OT - disseminated intravascular coagulation OT - heparin OT - mortality OT - outcome OT - sepsis-induced coagulopathy COIS- The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. EDAT- 2023/05/31 13:12 MHDA- 2023/05/31 13:13 PMCR- 2023/05/15 CRDT- 2023/05/31 10:38 PHST- 2023/02/25 00:00 [received] PHST- 2023/05/03 00:00 [accepted] PHST- 2023/05/31 13:13 [medline] PHST- 2023/05/31 13:12 [pubmed] PHST- 2023/05/31 10:38 [entrez] PHST- 2023/05/15 00:00 [pmc-release] AID - 1173893 [pii] AID - 10.3389/fphar.2023.1173893 [doi] PST - epublish SO - Front Pharmacol. 2023 May 15;14:1173893. doi: 10.3389/fphar.2023.1173893. eCollection 2023.