Heparin therapy reduces 28-day mortality in adult severe sepsis patients: a systematic review and meta-analysis

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• 作者：Changsong Wang (1)
  Chunjie Chi (1)
  Lei Guo (1)
  Xiaoyang Wang (1)
  Libo Guo (1)
  Jiaxiao Sun (2)
  Bo Sun (1)
  Shanshan Liu (1)
  Xuenan Chang (3)
  Enyou Li (1)
  
  1. Department of Anesthesiology ; First Affiliated Hospital of Harbin Medical University ; No 23 Youzheng Street ; Nangang District ; Harbin ; Heilongjiang ; 150001 ; China
  2. Department of Anesthesiology ; First Affiliated Hospital of Quan Zhou ; No. 151 Yanjiang West Road ; Yuexiu ; Quan Zhou ; Guangdong ; China
  3. Department of Anesthesiology ; Tianjin Huanhu Hospital ; No. 122 Qixiangtai Road ; Hexi ; Tian Jin ; 300060 ; China
  
• 刊名：Critical Care
• 出版年：2014
• 出版时间：October 2014
• 年：2014
• 卷：18
• 期：5
• 全文大小：592 KB
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• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

Introduction There are approximately 19 million new cases of sepsis worldwide each year. Among them, more than one quarter of patients die. We aimed to assess the effects of heparin on short-term mortality in adult patients with sepsis and severe sepsis. Methods We searched electronic databases (Medline, Embase, and Cochrane Library databases; the Cochrane Controlled Trials Register) and conference proceedings (Web of Knowledge (Conference Proceedings Citation Index - Science, Conference Proceedings Citation Index - Social Sciences & Humanities)) from inception to July 2014, expert contacts and relevant websites. Controlled trials of heparin versus placebo in sepsis or severe sepsis were identified. In total two reviewers independently assessed eligibility, and four authors independently extracted data; consensus was reached by conference. We used the chi-square test and I2 to assess statistical heterogeneity (P Results A total of nine publications were included in the meta-analysis. Heparin decreased 28-day mortality (n = 3,482, OR = 0.656, 95% CI = 0.562 to 0.765, P 2鈥?鈥?.0%). Heparin had no effect on bleeding events in sepsis (seven RCTs, n = 2,726; OR = 1.063; 95% CI = 0.834 to 1.355; P = 0.623; and I2鈥?鈥?0.9%). Subgroup analysis demonstrated that the sample size may be a source of heterogeneity, but experimental design was not. Conclusions Heparin may reduce 28-day mortality in patients with severe sepsis, at the same time, there was no increase in the risk of bleeding in the heparin group. We recommend the use of heparin for sepsis and severe sepsis.