Exploring the therapeutic role of early heparin administration in ARDS management: a MIMIC-IV database analysis

Ling-Xi Xiao; De Liang Zhu; Juan Chen; Jing Lv; Mei-Jun Liu; Xue Dai; Dao-Xin Wang; Wang Deng

doi:10.1186/s40560-024-00723-5

Exploring the therapeutic role of early heparin administration in ARDS management: a MIMIC-IV database analysis

J Intensive Care. 2024 Feb 26;12(1):9. doi: 10.1186/s40560-024-00723-5.

Authors

Ling-Xi Xiao^#¹, De Liang Zhu^#², Juan Chen¹, Jing Lv¹, Mei-Jun Liu¹, Xue Dai¹, Dao-Xin Wang¹, Wang Deng³

Affiliations

¹ Department of Pulmonary and Critical Care Medicine, Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong District, Chongqing, 400010, China.
² Department of Gastrointestinal Surgery, China-Japan Union Hospital of Jilin University, No. 126, Xiantai Street, Changchun, 130033, China.
³ Department of Pulmonary and Critical Care Medicine, Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong District, Chongqing, 400010, China. dengwang@hospital.cqmu.edu.cn.

^# Contributed equally.

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.

Keywords: Acute respiratory distress syndrome; Heparin; Intensive care units; MIMIC-IV database; Mortality; Propensity score.

Abstract

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