Hu Haiming, Zhu Yixing, Hu Ruikang, Zhao Lijuan, Zeng Xiangwen, Wu Xue, Qiu Rui, Nie Yihao, Sharma Lokesh, Chang De
Department of Pulmonary and Critical Care Medicine at The Seventh Medical Center, College of Pulmonary and Critical Care Medicine of The Eighth Medical Center, Chinese PLA General Hospital, Beijing, China.
Graduate School of Chinese PLA General Hospital, Beijing, China.
Front Pharmacol. 2025 May 8;16:1597885. doi: 10.3389/fphar.2025.1597885. eCollection 2025.
Coagulation disorders are common complications in patients with pulmonary infections. Studies have suggested beneficial effects of anticoagulant therapies in patients with COVID-19. However, the usefulness of prophylactic anticoagulant therapies in patients with non-COVID-19 pulmonary infections is still a matter of debate. This study aimed to assessed the impact of prophylactic anticoagulant therapy in ICU patients with non-COVID-19 pneumonia.
Patients were identified from the Medical Information Mart for Intensive Care-IV database. Propensity score matching (PSM) was utilized to minimize differences. Kaplan-Meier survival analysis was performed to assess mortality. Univariate and multivariate Cox regression models were used to identify prognostic factors for short-term mortality (7-day). The E-value was calculated to unmeasured confounding. To further explore the optimal anticoagulant administration, subgroup analyses were performed. We also explored the optimal administration strategies including the timing and duration of anticoagulant therapy.
A total of 1,000 ICU patients were included, with 500 receiving prophylactic anticoagulation therapy and 500 not. Both 7-day mortality (7.6% vs. 19.6%; p < 0.001) and 30-day mortality (19.6% vs. 31.2%; p < 0.001) in the anticoagulant group were lower than non-users. Kaplan-Meier survival analysis also showed a significantly lower prevalence of short-term mortality in patients who used anticoagulants. Both univariate (HR, 0.36; 95% CI, 0.25-0.53; p < 0.001) and multivariate (HR, 0.30; 95% CI, 0.21-0.44; p < 0.001) Cox regression analyses consistently demonstrated a significant reduction in short-term mortality associated with anticoagulation therapy. Subgroup analysis revealed that anticoagulant therapy was associated with reduced short-term mortality across most subgroups. Further analysis showed that late (≥6 h) and non-short-term (≥7 days) anticoagulation therapy were more effective.
Our results support the potential value of prophylactic anticoagulation therapy as a strategy to improve survival in ICU patients with non-COVID-19 pneumonia.
凝血功能障碍是肺部感染患者常见的并发症。研究表明抗凝治疗对新型冠状病毒肺炎（COVID-19）患者有益。然而，预防性抗凝治疗在非COVID-19肺部感染患者中的有效性仍存在争议。本研究旨在评估预防性抗凝治疗对非COVID-19肺炎重症监护病房（ICU）患者的影响。
从重症监护医学信息数据库-IV中识别患者。采用倾向得分匹配（PSM）以尽量减少差异。进行Kaplan-Meier生存分析以评估死亡率。使用单变量和多变量Cox回归模型确定短期死亡率（7天）的预后因素。计算E值以评估未测量的混杂因素。为进一步探索最佳抗凝给药方案，进行了亚组分析。我们还探讨了最佳给药策略，包括抗凝治疗的时机和持续时间。
共纳入1000例ICU患者，其中500例接受预防性抗凝治疗，500例未接受。抗凝组的7天死亡率（7.6%对19.6%；p<0.001）和30天死亡率（19.6%对31.2%；p<0.001）均低于未使用者。Kaplan-Meier生存分析还显示，使用抗凝剂的患者短期死亡率患病率显著较低。单变量（风险比[HR]，0.36；95%置信区间[CI]，0.25-0.53；p<0.001）和多变量（HR，0.30；95%CI，0.21-0.44；p<0.001）Cox回归分析均一致表明，抗凝治疗可显著降低短期死亡率。亚组分析显示，抗凝治疗在大多数亚组中均与短期死亡率降低相关。进一步分析表明，晚期（≥6小时）和非短期（≥7天）抗凝治疗更有效。
我们的结果支持预防性抗凝治疗作为改善非COVID-19肺炎ICU患者生存率的一种策略的潜在价值。
