Exploring the therapeutic role of early heparin administration in ARDS management: a MIMIC-IV database analysis
Abstract Background Acute respiratory distress syndrome (ARDS) is a severe respiratory condition characterized by a high mortality rate, the management of which relies on supportive care and a profound understanding of its pathophysiology. Heparin, with its anticoagulant and potential anti-inflammat...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-02-01
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| Series: | Journal of Intensive Care |
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| Online Access: | https://doi.org/10.1186/s40560-024-00723-5 |
| _version_ | 1797275657883877376 |
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| author | Ling-Xi Xiao De Liang Zhu Juan Chen Jing Lv Mei-Jun Liu Xue Dai Dao-Xin Wang Wang Deng |
| author_facet | Ling-Xi Xiao De Liang Zhu Juan Chen Jing Lv Mei-Jun Liu Xue Dai Dao-Xin Wang Wang Deng |
| author_sort | Ling-Xi Xiao |
| collection | DOAJ |
| description | Abstract Background Acute respiratory distress syndrome (ARDS) is a severe respiratory condition characterized by a high mortality rate, the management of which relies on supportive care and a profound understanding of its pathophysiology. Heparin, with its anticoagulant and potential anti-inflammatory properties, offers a new therapeutic opportunity for the treatment of ARDS. Methods In this retrospective cohort study, we examined the MIMIC-IV database for ARDS patients who received prophylactic heparin within the first 72 h of ICU admission. Employing propensity score matching and inverse probability weighting (IPW) analysis, we evaluated the impact of early heparin use on patient outcomes, focusing on mortality rates. Results Patients who received prophylactic heparin had a significantly lower in-hospital mortality rate compared to those who did not (13.55% vs 17.93%, HR = 0.71, 95% CI: 0.54–0.93, P = 0.012). This result remained significant after propensity score matching (12.75% vs 17.93%, HR = 0.65, 95% CI 0.47–0.90, P = 0.010). Analysis using five different statistical models indicated that early use of heparin significantly reduced the in-hospital mortality rate, with HR = 0.669 (95% CI 0.487–0.919, P = 0.013) in the doubly robust model without balanced covariates; HR = 0.705 (95% CI 0.515–0.965, P = 0.029) with all covariates considered; HR = 0.660 (95% CI 0.491–0.888, P = 0.006) in the propensity score (IPW) model; HR = 0.650 (95% CI 0.470–0.900, P = 0.010) in the propensity score matching model; and HR = 0.706 (95% CI 0.536–0.930, P = 0.013) in the multivariate Cox regression model. Secondary outcomes indicated that heparin use was also associated with reduced mortality rates at 60 days, and 90 days. Conclusion This research highlights that early prophylactic administration of heparin may substantially lower mortality in ARDS patients. These findings underscore the potential of heparin as a key component in the management of ARDS, offering a new perspective and novel strategies for clinical treatment. |
| first_indexed | 2024-03-07T15:17:37Z |
| format | Article |
| id | doaj.art-0162a402e7024512988ae057d1a74ee4 |
| institution | Directory Open Access Journal |
| issn | 2052-0492 |
| language | English |
| last_indexed | 2024-03-07T15:17:37Z |
| publishDate | 2024-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Intensive Care |
| spelling | doaj.art-0162a402e7024512988ae057d1a74ee42024-03-05T17:50:07ZengBMCJournal of Intensive Care2052-04922024-02-0112111410.1186/s40560-024-00723-5Exploring the therapeutic role of early heparin administration in ARDS management: a MIMIC-IV database analysisLing-Xi Xiao0De Liang Zhu1Juan Chen2Jing Lv3Mei-Jun Liu4Xue Dai5Dao-Xin Wang6Wang Deng7Department of Pulmonary and Critical Care Medicine, Second Affiliated Hospital of Chongqing Medical UniversityDepartment of Gastrointestinal Surgery, China-Japan Union Hospital of Jilin UniversityDepartment of Pulmonary and Critical Care Medicine, Second Affiliated Hospital of Chongqing Medical UniversityDepartment of Pulmonary and Critical Care Medicine, Second Affiliated Hospital of Chongqing Medical UniversityDepartment of Pulmonary and Critical Care Medicine, Second Affiliated Hospital of Chongqing Medical UniversityDepartment of Pulmonary and Critical Care Medicine, Second Affiliated Hospital of Chongqing Medical UniversityDepartment of Pulmonary and Critical Care Medicine, Second Affiliated Hospital of Chongqing Medical UniversityDepartment of Pulmonary and Critical Care Medicine, Second Affiliated Hospital of Chongqing Medical UniversityAbstract Background Acute respiratory distress syndrome (ARDS) is a severe respiratory condition characterized by a high mortality rate, the management of which relies on supportive care and a profound understanding of its pathophysiology. Heparin, with its anticoagulant and potential anti-inflammatory properties, offers a new therapeutic opportunity for the treatment of ARDS. Methods In this retrospective cohort study, we examined the MIMIC-IV database for ARDS patients who received prophylactic heparin within the first 72 h of ICU admission. Employing propensity score matching and inverse probability weighting (IPW) analysis, we evaluated the impact of early heparin use on patient outcomes, focusing on mortality rates. Results Patients who received prophylactic heparin had a significantly lower in-hospital mortality rate compared to those who did not (13.55% vs 17.93%, HR = 0.71, 95% CI: 0.54–0.93, P = 0.012). This result remained significant after propensity score matching (12.75% vs 17.93%, HR = 0.65, 95% CI 0.47–0.90, P = 0.010). Analysis using five different statistical models indicated that early use of heparin significantly reduced the in-hospital mortality rate, with HR = 0.669 (95% CI 0.487–0.919, P = 0.013) in the doubly robust model without balanced covariates; HR = 0.705 (95% CI 0.515–0.965, P = 0.029) with all covariates considered; HR = 0.660 (95% CI 0.491–0.888, P = 0.006) in the propensity score (IPW) model; HR = 0.650 (95% CI 0.470–0.900, P = 0.010) in the propensity score matching model; and HR = 0.706 (95% CI 0.536–0.930, P = 0.013) in the multivariate Cox regression model. Secondary outcomes indicated that heparin use was also associated with reduced mortality rates at 60 days, and 90 days. Conclusion This research highlights that early prophylactic administration of heparin may substantially lower mortality in ARDS patients. These findings underscore the potential of heparin as a key component in the management of ARDS, offering a new perspective and novel strategies for clinical treatment.https://doi.org/10.1186/s40560-024-00723-5Acute respiratory distress syndromeHeparinPropensity scoreIntensive care unitsMortalityMIMIC-IV database |
| spellingShingle | Ling-Xi Xiao De Liang Zhu Juan Chen Jing Lv Mei-Jun Liu Xue Dai Dao-Xin Wang Wang Deng Exploring the therapeutic role of early heparin administration in ARDS management: a MIMIC-IV database analysis Journal of Intensive Care Acute respiratory distress syndrome Heparin Propensity score Intensive care units Mortality MIMIC-IV database |
| title | Exploring the therapeutic role of early heparin administration in ARDS management: a MIMIC-IV database analysis |
| title_full | Exploring the therapeutic role of early heparin administration in ARDS management: a MIMIC-IV database analysis |
| title_fullStr | Exploring the therapeutic role of early heparin administration in ARDS management: a MIMIC-IV database analysis |
| title_full_unstemmed | Exploring the therapeutic role of early heparin administration in ARDS management: a MIMIC-IV database analysis |
| title_short | Exploring the therapeutic role of early heparin administration in ARDS management: a MIMIC-IV database analysis |
| title_sort | exploring the therapeutic role of early heparin administration in ards management a mimic iv database analysis |
| topic | Acute respiratory distress syndrome Heparin Propensity score Intensive care units Mortality MIMIC-IV database |
| url | https://doi.org/10.1186/s40560-024-00723-5 |
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