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IntroductionThere are approximately 19 million new cases of sepsis worldwide each year. Among them, more than one quarter of patients die. We aimed to assess the effects of heparin on short-term mortality in adult patients with sepsis and severe sepsis.MethodsWe searched electronic databases (Medline, Embase, and Cochrane Library databases; the Cochrane Controlled Trials Register) and conference proceedings (Web of Knowledge (Conference Proceedings Citation Index - Science, Conference Proceedings Citation Index - Social Sciences & Humanities)) from inception to July 2014, expert contacts and relevant websites. Controlled trials of heparin versus placebo in sepsis or severe sepsis were identified. In total two reviewers independently assessed eligibility, and four authors independently extracted data; consensus was reached by conference. We used the chi-square test and I2 to assess statistical heterogeneity (P <0.05). The primary analysis was based on the fixed-effect model to produce pooled odds ratios with 95% confidence intervals.ResultsA total of nine publications were included in the meta-analysis. Heparin decreased 28-day mortality (n = 3,482, OR = 0.656, 95% CI = 0.562 to 0.765, P <0.0001). According to the meta-analysis of 28-day mortality, heterogeneity was not found among the eight randomized clinical trials (RCTs) (I2 = 0.0%). Heparin had no effect on bleeding events in sepsis (seven RCTs, n = 2,726; OR = 1.063; 95% CI = 0.834 to 1.355; P = 0.623; and I2 = 20.9%). Subgroup analysis demonstrated that the sample size may be a source of heterogeneity, but experimental design was not.ConclusionsHeparin may reduce 28-day mortality in patients with severe sepsis, at the same time, there was no increase in the risk of bleeding in the heparin group. We recommend the use of heparin for sepsis and severe sepsis.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-014-0563-4) contains supplementary material, which is available to authorized users.

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This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. constrainted to be between 490 and ~600 Ma. Our data suggest that the granulite terrane in the eastern Himalayan syntaxis has an affinity with the Greater Himalayan Series. The HP granulite-facies metamorphic events in the eastern Himalayan syntaxis are distinct from ultrahigh pressure (UHP) metamorphic events in the western Himalayan syntaxis in both age and depth of burial. However, the metamorphic history of the eastern and western Himalayan syntaxises becomes similar after ~24 Ma. The Namche Barwa granulites appear to result from the underthrusting of the Indian plate lithologies beneath the Lhasa block during progressive collisional processes, followed by extrusion and/or exhumation that result from a slab breakoff of the Indian plate during the Miocene. A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT

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