Impact of early heparin therapy on mortality in critically ill patients with sepsis-related acute respiratory distress syndrome: a MIMIC-IV database analysis

Background Sepsis-associated acute respiratory distress syndrome (ARDS) is a life-threatening condition marked by significant thromboinflammation. Heparin, which has both anticoagulant and anti-inflammatory effects, may influence these pathways. However, its role in sepsis-related ARDS has not been fully explored. Methods Data for this retrospective cohort study were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Patients were divided into two groups: those who received prophylactic heparin therapy at least once during their ICU stay and those who did not. The primary endpoint was intensive care unit (ICU) mortality, with secondary outcomes including 7-day, 14-day, 28-day, and in-hospital mortality. Propensity score matching (PSM), univariate Cox regression analysis, Kaplan-Meier curve analysis, multivariate Cox modeling, sensitivity analysis, and E-value analysis were performed. Results A total of 6,454 patients were included in this study: 2,528 received early heparin therapy, and 3,926 did not. Early heparin therapy was associated with a significant reduction in ICU mortality, 7-day, 14-day, 28-day, and in-hospital mortality in patients with sepsis-associated ARDS, and this effect remained significant following PSM ( P  < 0.001). The association between early heparin therapy and reduced ICU mortality (HR = 0.72, 95% CI : 0.62–0.82, P  < 0.01) persisted after adjusting for confounding variables and was more pronounced in patients aged < 60 years and those with a high body weight. E-value analyses demonstrated robustness to unmeasured confounders. Conclusion Early heparin therapy is correlated with decreased mortality in critically ill patients with sepsis-related ARDS. These findings provide a rationale for further exploring heparin as an adjunctive therapy.