Heparin therapy reduces 28-day mortality in adult severe sepsis patients: a systematic review and meta-analysis.
Heparin therapy reduces 28-day mortality in adult severe sepsis patients: a systematic review and meta-analysis.
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肝素治疗可降低成年严重脓毒症患者 28 天死亡率：系统评价和荟萃分析
DOI：
10.1186/s13054-014-0563-4
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发表时间：
2014-10-16
期刊：
影响因子：
--
通讯作者：
Li E
中科院分区：
文献类型：
--
作者：
Wang C;Chi C;Guo L;Wang X;Guo L;Sun J;Sun B;Liu S;Chang X;Li E
全世界每年大约有1900万新发脓毒症病例。其中，超过四分之一的患者死亡。我们的目的是评估肝素对脓毒症和严重脓毒症成年患者短期死亡率的影响。方法检索成立至2014年7月的电子数据库（Medline、Embase和Cochrane Library数据库；Cochrane对照试验注册库）和会议论文集（Web of Knowledge（会议论文集引文索引- Science，会议论文集引文索引- Social Sciences & Humanities））、专家联系方式和相关网站。肝素与安慰剂在脓毒症或严重脓毒症中的对照试验被确定。共有2位审稿人独立评估入选资格，4位作者独立提取数据；会议达成了共识。我们采用卡方检验和i2来评估统计异质性（P<0.05）。初步分析基于固定效应模型，得出95%置信区间的合并优势比。结果meta分析共纳入9篇文献。肝素降低28天死亡率（n = 3,482, OR = 0.656, 95% CI = 0.562 ~ 0.765，P<0.0001）。根据28天死亡率的荟萃分析，8项随机临床试验（rct）之间没有发现异质性（I2= 0.0%）。肝素对脓毒症出血事件无影响（7项rct， n = 2726; OR = 1.063; 95% CI = 0.834 ~ 1.355；P= 0.623; I2= 20.9%）。亚组分析表明，样本量可能是异质性的来源，但实验设计不是。结论肝素可降低严重脓毒症患者28天死亡率，同时肝素组未增加出血风险。我们推荐使用肝素治疗败血症和严重败血症。
IntroductionThere 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.MethodsWe 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 I2to assess statistical heterogeneity (P<0.05). The primary analysis was based on the fixed-effect model to produce pooled odds ratios with 95% confidence intervals.ResultsA 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<0.0001). According to the meta-analysis of 28-day mortality, heterogeneity was not found among the eight randomized clinical trials (RCTs) (I2= 0.0%). 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= 20.9%). Subgroup analysis demonstrated that the sample size may be a source of heterogeneity, but experimental design was not.ConclusionsHeparin 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.
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