Key result
Early heparin linked to ~21% lower 28-day mortality in sepsis-induced myocardial injury.
Why the study?
The efficacy of heparin therapy in sepsis-induced myocardial injury remains uncertain.
Does early heparin use reduce all-cause mortality in ICU patients with sepsis-induced myocardial injury?
Cohort (n=2,550)
Does early heparin use reduce all-cause mortality in ICU patients with sepsis-induced myocardial injury?
Hazard Ratio: 0.786 (95% CI 0.7–0.883)
p-value: p=<0.001
Early heparin administration within 72 hours of ICU admission is associated with significantly reduced short- and long-term all-cause mortality in patients with sepsis-induced myocardial injury.
Should not yet change practice; hypothesis-generating association leaves causality open pending RCTs in sepsis-induced myocardial injury.
BACKGROUND: The efficacy of heparin therapy in sepsis remains uncertain. OBJECTIVE: To investigate the association between early heparin use and outcomes in patients with sepsis-induced myocardial injury (SIMI) and to explore potential cardioprotective mechanisms in experimental models. METHODS: The present study employed a target trial emulation (TTE) using data from the MIMIC-IV database to investigate intensive care unit (ICU) patients with SIMI. The cloning-censoring-weighting (CCW) method was used to address immortal time bias. Early heparin use was defined as administration within 72 h of ICU admission. Weighted Cox proportional hazards models were applied to assess its association with 28-day, 90-day, and 365-day all-cause mortality, with sensitivity analyses conducted in the propensity score-matched (PSM) cohort. In parallel, murine SIMI models induced by lipopolysaccharide (LPS) and cecal ligation and puncture (CLP) were used to explore the potential cardioprotective effects of heparin. RESULTS: A total of 2,550 patients with SIMI were included. In the TTE analysis, early heparin initiation was associated with lower 28-day mortality (hazard ratio [HR] = 0.786, 95% confidence interval [CI]: 0.700-0.883, P < 0.001), 90-day mortality (HR = 0.768, 95% CI: 0.691-0.854, P < 0.001), and 365-day mortality (HR = 0.789, 95% CI: 0.715-0.870, P < 0.001). In experimental models, heparin treatment significantly attenuated myocardial injury and improved survival. CONCLUSIONS: Early heparin use was associated with reduced mortality in patients with SIMI, while experimental studies suggested potential cardioprotective effects in septic mice.
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Yin et al. (2026) conducted a cohort in Sepsis-induced myocardial injury (SIMI) (n=2,550). Early heparin use was evaluated on 28-day all-cause mortality (HR 0.786, 95% CI 0.700-0.883, p=<0.001). Early heparin initiation within 72 hours of ICU admission was associated with lower 28-day mortality in patients with sepsis-induced myocardial injury (HR 0.786; 95% CI 0.700-0.883; P<0.001).
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