Fu Linlin, Li Hanyang, Ni Qian, Zhu Qiaoling, Wang Baoyan
Department of Pharmacy, Nanjing Drum Tower Hospital, Basic Medicine and Clinical Pharmacy College, China Pharmaceutical University, 210008, Nanjing, China.
Department of Biochemistry and Molecular Biology, Nanjing Medical University, 211166, Nanjing, China.
BMC Gastroenterol. 2025 Mar 24;25(1):195. doi: 10.1186/s12876-025-03763-9.
Acute pancreatitis is a critical condition in the intensive care unit (ICU), often complicated by systemic issues, which may benefit from heparin therapy due to its anti-inflammatory and anticoagulant properties. However, the optimal duration of heparin therapy remained unclear. This retrospective study aimed to evaluate the association between heparin therapy duration and mortality outcomes in patients diagnosed with acute pancreatitis.
This retrospective study utilized data from the Medical Information Mart for Intensive Care (MIMIC-IV) and eICU Collaborative Research Database (eICU-CRD), including 1705 patients diagnosed with acute pancreatitis between 2008 and 2019. Restricted cubic splines (RCS) were employed to analyze the non-linear relationship between heparin therapy duration and 30-day and 90-day mortality. Patients were categorized into four groups based on quartiles: < 4 days, 4-7 days, 8-14 days, and > 14 days, using characteristics identified in the RCS curves, with 4-7 days as the reference. Cox multivariate regression and Kaplan-Meier analysis assessed the association between these groups and mortality, with 30-day mortality as the primary outcome and 90-day mortality as the secondary outcome.
The relationship between heparin therapy duration and mortality at 30 and 90 days in patients with acute pancreatitis exhibited a J-shaped curve, with the lowest mortality observed around 7 days for both 30-day and 90-day mortality. Heparin therapy durations less than 4 days were significantly associated with higher 30-day mortality (HR: 2.57, 95% CI: 1.53-4.30) and increased 90-day mortality (HR: 1.57, 95% CI: 1.07-2.32), with mortality stabilizing beyond 7 days of therapy. Subgroup analysis stratified by severity consistently supported these findings.
In critically ill patients with acute pancreatitis, heparin therapy lasting less than 4 days was associated with increased 30-day and 90-day mortality, whereas the lowest mortality was observed among patients receiving heparin therapy for approximately 7 days.
急性胰腺炎是重症监护病房（ICU）中的一种危急病症，常伴有全身性问题，因其抗炎和抗凝特性，肝素治疗可能对其有益。然而，肝素治疗的最佳持续时间仍不明确。这项回顾性研究旨在评估肝素治疗持续时间与急性胰腺炎患者死亡率之间的关联。
这项回顾性研究利用了重症监护医学信息集市（MIMIC-IV）和电子ICU协作研究数据库（eICU-CRD）的数据，包括2008年至2019年间诊断为急性胰腺炎的1705例患者。采用受限立方样条（RCS）分析肝素治疗持续时间与30天和90天死亡率之间的非线性关系。根据四分位数将患者分为四组：<4天、4-7天、8-14天和>14天，使用RCS曲线中确定的特征，以4-7天为参照。Cox多因素回归和Kaplan-Meier分析评估了这些组与死亡率之间的关联，以30天死亡率作为主要结局，90天死亡率作为次要结局。
急性胰腺炎患者肝素治疗持续时间与30天和90天死亡率之间的关系呈J形曲线，30天和90天死亡率在约7天时观察到最低死亡率。肝素治疗持续时间少于4天与30天死亡率显著升高（HR：2.57，95%CI：1.53-4.30）和90天死亡率增加（HR：1.57，95%CI：1.07-2.32）相关，治疗超过7天后死亡率趋于稳定。按严重程度分层的亚组分析一致支持这些发现。
在患有急性胰腺炎的重症患者中，肝素治疗持续时间少于4天与30天和90天死亡率增加相关，而在接受肝素治疗约7天的患者中观察到最低死亡率。
