Wang Changsong, Chi Chunjie, Guo Lei, Wang Xiaoyang, Guo Libo, Sun Jiaxiao, Sun Bo, Liu Shanshan, Chang Xuenan, Li Enyou
Crit Care. 2014 Oct 16;18(5):563. doi: 10.1186/s13054-014-0563-4.
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.
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 <0.05). The primary analysis was based on the fixed-effect model to produce pooled odds ratios with 95% confidence intervals.
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 <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.
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.
全球每年约有1900万例新发脓毒症病例。其中，超过四分之一的患者死亡。我们旨在评估肝素对成年脓毒症和严重脓毒症患者短期死亡率的影响。
我们检索了电子数据库（Medline、Embase和Cochrane图书馆数据库；Cochrane对照试验注册库）以及自创建至2014年7月的会议论文集（《科学网会议论文引用索引》《社会科学与人文科学会议论文引用索引》）、专家联系人及相关网站。确定了肝素与安慰剂用于脓毒症或严重脓毒症的对照试验。总共两名评审员独立评估入选资格，四名作者独立提取数据；通过会议达成共识。我们使用卡方检验和I²评估统计异质性（P<0.05）。主要分析基于固定效应模型，以生成具有95%置信区间的合并比值比。
荟萃分析共纳入9篇出版物。肝素降低了28天死亡率（n = 3482，OR = 0.656，95% CI = 0.562至0.765，P<0.0001）。根据28天死亡率的荟萃分析，在八项随机临床试验（RCT）中未发现异质性（I² = 0.0%）。肝素对脓毒症患者的出血事件无影响（七项RCT，n = 2726；OR = 1.063；95% CI = 0.834至1.355；P = 0.623；I² = 20.9%）。亚组分析表明，样本量可能是异质性的一个来源，但实验设计不是。
肝素可能降低严重脓毒症患者的28天死亡率，同时，肝素组出血风险未增加。我们建议对脓毒症和严重脓毒症使用肝素。
