Liu Ying, Peng Jiao, Zhang Yuan-Hui, Liu Hai-Tao
Department of Anaesthesiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, China.
Department of Anaesthesiology, Leshan Shizhong District People's Hospital, Leshan, Sichuan, China.
World Neurosurg. 2025 Feb;194:123539. doi: 10.1016/j.wneu.2024.11.122. Epub 2024 Dec 23.
Subarachnoid hemorrhage (SAH) is a severe neurologic event with high mortality. The choice of sedatives in SAH management may influence patient outcomes. This study aimed to investigate the association between sedatives and in-hospital mortality among patients with SAH.
This study analyzed data from the MIMIC-IV database, and in-hospital mortality was the primary outcome. Key variables collected included sedatives, demographics, comorbidities, vital signs, laboratory tests, and severity scores. Univariate and multivariate logistic regression analyses were used to assess associations between sedative use and in-hospital mortality, with adjustments for confounding factors. Further stratified analyses explored the effects of dexmedetomidine across different patient subgroups, and mediation analysis evaluated the role of creatinine in the relationship between dexmedetomidine and mortality.
A total of 527 patients were included in this study, with 301 males. Compared with propofol and midazolam, the use of dexmedetomidine was significantly related to the reduction of in-hospital mortality in patients with SAH (odds ratio, 0.369; 95% confidence interval, 0.237-0.574; P < 0.001). After adjusting for variables such as demographics, comorbidities, and laboratory tests, dexmedetomidine remained associated with lower in-hospital mortality. In addition, our findings indicated that dexmedetomidine use was associated with a reduced risk of in-hospital mortality regardless of the presence of cerebrovascular disease. We discovered that creatinine acted as a mediator in the protective effect of dexmedetomidine on in-hospital mortality.
Dexmedetomidine is associated with significantly lower in-hospital mortality in patients with SAH. These findings underscore the importance of sedative choice for patients with SAH, suggesting that dexmedetomidine could enhance patient outcomes.
蛛网膜下腔出血（SAH）是一种严重的神经系统事件，死亡率很高。SAH管理中镇静剂的选择可能会影响患者的预后。本研究旨在调查SAH患者使用镇静剂与院内死亡率之间的关联。
本研究分析了MIMIC-IV数据库中的数据，院内死亡率是主要结局。收集的关键变量包括镇静剂、人口统计学、合并症、生命体征、实验室检查和严重程度评分。采用单因素和多因素逻辑回归分析评估镇静剂使用与院内死亡率之间的关联，并对混杂因素进行调整。进一步的分层分析探讨了右美托咪定在不同患者亚组中的作用，中介分析评估了肌酐在右美托咪定与死亡率关系中的作用。
本研究共纳入527例患者，其中男性301例。与丙泊酚和咪达唑仑相比，SAH患者使用右美托咪定与院内死亡率降低显著相关（比值比，0.369；95%置信区间，0.237-0.574；P<0.001）。在调整了人口统计学、合并症和实验室检查等变量后，右美托咪定仍与较低的院内死亡率相关。此外，我们的研究结果表明，无论是否存在脑血管疾病，使用右美托咪定都与降低院内死亡风险相关。我们发现肌酐在右美托咪定对院内死亡率的保护作用中起中介作用。
右美托咪定与SAH患者显著降低的院内死亡率相关。这些发现强调了SAH患者镇静剂选择的重要性，表明右美托咪定可以改善患者预后。
