BMJ open · 2025
Association between dexmedetomidine sedation and mortality in critically ill patients with ischaemic stroke: a retrospective study based on MIMIC-IV database.
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Yang Yuecheng, Zhang Jingying, Wang Haoyuan, Zhang Yunkui, Zhang Jun
Аннотация
OBJECTIVE: This study investigates the effects of dexmedetomidine on short-term and long-term survival rates in intensive care unit (ICU) patients with ischaemic stroke.
DESIGN: This is a retrospective study.
SETTING: Data were sourced from the Medical Information Mart for Intensive Care IV database.
PARTICIPANTS: This study analysed 2816 patients with ischaemic stroke from the US Intensive Care database.
INTERVENTIONS: Dexmedetomidine administration during the ICU stay was defined as the exposure.
METHODS: Patients were categorised into the dexmedetomidine group and the control group. Cox regression analysis was used to identify factors that may influence the 28-day mortality rate of patients with ischaemic stroke. High-risk factors were incorporated as covariates, and a 1:1 propensity score matching using the logit model was constructed to compare the prognosis between the two groups.
PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was 28-day mortality. The secondary outcomes included in-hospital mortality, ICU length of stay, hospital length of stay, mechanical ventilation duration and 180-day mortality in discharged patients.
RESULTS: A total of 2816 patients were included. Cox regression analysis revealed that dexmedetomidine use was associated with a reduced risk of 28-day mortality. Following propensity score matching, each group comprised 407 patients. Dexmedetomidine was found to improve 28-day mortality (27.8% vs 36.6%, p=0.007). However, it was also associated with the prolonged length of hospital and ICU stay (p=0.002). Among discharged patients, dexmedetomidine use was also associated with an improved 180-day mortality rate (p=0.0019).
CONCLUSION: The use of dexmedetomidine is associated with improved short-term and long-term prognosis in patients with ischaemic stroke and could potentially confer benefits in those receiving mechanical ventilation.
DESIGN: This is a retrospective study.
SETTING: Data were sourced from the Medical Information Mart for Intensive Care IV database.
PARTICIPANTS: This study analysed 2816 patients with ischaemic stroke from the US Intensive Care database.
INTERVENTIONS: Dexmedetomidine administration during the ICU stay was defined as the exposure.
METHODS: Patients were categorised into the dexmedetomidine group and the control group. Cox regression analysis was used to identify factors that may influence the 28-day mortality rate of patients with ischaemic stroke. High-risk factors were incorporated as covariates, and a 1:1 propensity score matching using the logit model was constructed to compare the prognosis between the two groups.
PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was 28-day mortality. The secondary outcomes included in-hospital mortality, ICU length of stay, hospital length of stay, mechanical ventilation duration and 180-day mortality in discharged patients.
RESULTS: A total of 2816 patients were included. Cox regression analysis revealed that dexmedetomidine use was associated with a reduced risk of 28-day mortality. Following propensity score matching, each group comprised 407 patients. Dexmedetomidine was found to improve 28-day mortality (27.8% vs 36.6%, p=0.007). However, it was also associated with the prolonged length of hospital and ICU stay (p=0.002). Among discharged patients, dexmedetomidine use was also associated with an improved 180-day mortality rate (p=0.0019).
CONCLUSION: The use of dexmedetomidine is associated with improved short-term and long-term prognosis in patients with ischaemic stroke and could potentially confer benefits in those receiving mechanical ventilation.