The association between thiamine use and mortality in critically ill patients with sepsis-associated acute respiratory failure: A retrospective analysis of the MIMIC-IV database.

BACKGROUND

Thiamine (vitamin B1) is a crucial cofactor in energy metabolism and antioxidant defense, yet its specific impact on patients with sepsis-associated acute respiratory failure remains unclear.

METHODS

We conducted a retrospective cohort study of 6248 sepsis-associated acute respiratory failure patients in the MIMIC-IV database (2008-2019). Patients were categorized based on thiamine supplementation. The primary endpoints were in-hospital and ICU mortality, analyzed using Kaplan-Meier curves, multivariable Cox regression, propensity score matching (PSM), and subgroup analyses.

RESULTS

The thiamine group comprised 1576 patients and the no-thiamine group 4672. After adjustment, the no thiamine group had a higher risk of hospital mortality (HR = 1.24, 95%CI 1.10-1.39) and ICU mortality (HR = 1.31, 95%CI 1.14-1.51). This protective association was confirmed in the PSM-matched cohort (n = 2784). Subgroup analysis indicated the benefit was most pronounced in patients aged ≥65 years, with no significant association observed in younger patients.

CONCLUSION

Thiamine supplementation was independently associated with reduced in-hospital and ICU mortality in critically ill patients with sepsis-associated acute respiratory failure, particularly in the elderly.These findings support the need for randomized controlled trials to validate its potential as an adjunctive therapy.