Background
Methods
Design
Patient population
Patient data collection
Outcome measures
Statistical analysis
Results
Patient populations
No Heparin n = 559 | Heparin n = 164 |
pvalue | |
---|---|---|---|
Age, mean (SD) | 59 (17) | 63 (14) | 0.003 |
Male,% (n) | 70 (389) | 63 (103) | 0.10 |
APACHE II score, mean (SD) | 17.8 (6.9) | 19.8 (6.5) | 0.001 |
Medical patients,% (n) | 60 (334) | 71 (117) | 0.007 |
Surgery elective,% (n) | 23 (128) | 19 (31) | 0.28 |
Surgery emergency,% (n) | 17 (97) | 7 (16) | 0.02 |
Medical condition | |||
Multiple Trauma,% (n) | 8 (43) | 2 (3) | 0.007 |
Sepsis,% (n) | 21 (115) | 18 (29) | 0.42 |
Diabetes,% (n) | 14 (81) | 16 (27) | 0.53 |
Liver Failure,% (n) | 3 (14) | 2 (4) | 0.96 |
Hematological malignancy,% (n) | 6 (35) | 2 (3) | 0.03 |
Aspiration,% (n) | 5 (26) | 4 (6) | 0.59 |
Pancreatitis,% (n) | 2 (12) | 2 (4) | 0.82 |
Pneumonia,% (n) | 23 (129) | 10 (17) | < 0.001 |
COPD | 11 (62) | 14 (23) | 0.31 |
Auto immune disease,% (n) | 6 (34) | 9 (15) | 0.17 |
Previous Myocardial infarction,% (n) | 13 (72) | 40 (66) | < 0.001 |
Immune Compromised,% (n) | 11 (61) | 6 (10) | 0.07 |
Massive Transfusion,% (n) | 14 (78) | 12 (19) | 0.43 |
Life support measures | |||
Respiratory failure (MV) ,% (n) | 93 (519) | 95 (156) | 0.42 |
Cardiovascular failure (MI) ,% (n) | 13 (72) | 40 (66) | <0.001 |
Co interventions | |||
Activated Protein C,% (n) | 4 (24) | 1 (1) | 0.02 |
Stress dose steroids,% (n) | 42 (233) | 46 (76) | 0.29 |
Protective mechanical ventilation (<8 ml/kg) ,% (n) | 54 (304) | 55 (91) | 0.29 |
Restrictive fluid strategy (net fluid balance first 7 days ≤ 0 ml) ,% (n) | 36 (203) | 35 (58) | 0.82 |
Outcome | |||
28 days mortality,% (n) | 24 (134) | 30 (50) | 0.09 |
90 days mortality,% (n) | 32 (181) | 39 (64) | 0.11 |
ICU-stay, median (IQR) | 7 (4–13) | 7 (4–13) | 0.59 |
Hospital-stay, median (IQR) | 20 (11–38) | 18 (8–37) | 0.13 |
Propensity matching
OR (95% CI) |
Pvalue*
| |
---|---|---|
Age | 1.02 (1.00/1.03) | 0.002 |
Male | 1.39 (0.92/1.86) | 0.13 |
APACHE II score | 1.09 (1.06/1.12) | < 0.001 |
Medical | 1.94 (1.34/2.81) | < 0.001 |
Surgery Elective | 0.40 (0.25/0.65) | < 0.001 |
Surgery Emergency | 0.91 (0.57/1.45) | 0.68 |
Medical conditions | ||
Multiple Trauma | 0.51 (0.22/1.15) | 0.11 |
Sepsis | 1.27 (0.84/1.90) | 0.25 |
Diabetes | 1.83 (1.18/2.83) | 0.006 |
Liver Failure | 3.82 (1.48/9.82) | 0.006 |
Hematological malignancy | 1.77 (0.89/3.49) | 0.10 |
Aspiration | 1.35 (0.63/2.91) | 0.44 |
Pancreatitis | 0.67 (0.19/2.38) | 0.54 |
Pneumonia | 1.14 (0.75/1.71) | 0.55 |
COPD | 1.26 (0.76/2.07) | 0.37 |
Auto immune disease | 1.95 (1.07/3.56) | 0.03 |
Previous Myocardial infarction | 1.25 (0.83/1.89) | 0.29 |
Immune Compromised | 1.69 (1.00/2.83) | 0.05 |
Massive Transfusion | 0.68 (0.40/1.16) | 0.16 |
Life support measures | ||
Respiratory failure at admission | 1.00 (0.98/1.02) | 0.99 |
Cardiovascular failure (inotropic at admission) | 1.00 (0.98/1.02) | 0.84 |
Co interventions | ||
Activated Protein C | 1.40 (0.59/3.29) | 0.45 |
Stress dose steroids | 1.89 (1.34/2.64) | < 0.001 |
Protective mechanical ventilation (<8 ml/kg) | 0.63 (0.45/0.89) | 0.008 |
Restrictive fluid strategy (net fluid balance first 7 days ≤ 0 ml) | 0.33 (0.22/0.49) | < 0.001 |
Mortality rate (No. deaths/total No. of patients) | OR (95% CI) |
p
| |
---|---|---|---|
Heparin use1 (28-day mortality) | 30 (50/164) | 1.22 (0.79/1.90) | 0.36 |
Heparin use1 (90-day mortality) | 39 (64/164) | 1.08 (0.73/1.59) | 0.71 |
Primary and secondary outcome
Mortality rate (No. deaths/total No. of patients) | OR (95% CI) |
p
| |
---|---|---|---|
aPTT ≤ 45 (all patients) | 25.4 (184/723) | 0.64 (0.43/.96) | 0.03 |
aPTT ≤ 451 (patients using heparin) | 31 (50/164) | 0.66 (0.30/1.45) | 0.26 |
aPTT ≤ 452 (patients not using heparin) | 24 (134/559) | 0.54 (0.34/0.87) | 0.007 |
Pooled results 1,2
| 0.57 (0.38/0.86) | 0.005 |