Liu Yuan, Ouyang Jianjie, Zhang Cuicui, Niu Pingping, Shang Baoling, Yao Gengzhen, Shi Yongyong, Zou Xu
Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
Department of Cardiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.
Front Pharmacol. 2025 Jan 15;15:1529167. doi: 10.3389/fphar.2024.1529167. eCollection 2024.
The efficacy of dexmedetomidine (DEX) in treating sepsis-induced myocardial injury (SIMI) remains unclear. In this study, we explored the relationship between DEX use and clinical outcomes of patients with SIMI, focusing on the dosage and treatment duration.
In this retrospective cohort analysis, we identified patients with SIMI from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database and categorized them into the DEX and non-DEX groups based on intensive care unit treatment. The baseline bias was reduced through propensity score matching (PSM). The primary outcome was 28-day mortality, whereas the secondary outcomes were in-hospital mortality and mortality rates at 7 days, 90 days, and 1 year. The association between DEX use and in-hospital mortality was assessed using Kaplan-Meier analysis and Cox proportional hazards models.
After PSM, 373 patients in the DEX group were matched with 579 patients in the non-DEX group to achieve a balanced distribution of the covariates. The Cox regression model demonstrated a significant reduction in the 28-day mortality associated with DEX use, yielding a hazard ratio (HR) of 0.61 (95% confidence interval [CI]: 0.47-0.78, P < 0.001). In-hospital mortality also significantly decreased (HR = 0.43, 95% CI: 0.33-0.57, P < 0.001). Lower mortality rates were observed at 7 days, 90 days, and 1 year. DEX doses >0.4 μg/kg/h, particularly in the range of 0.400-0.612 μg/kg/h, total doses >3.113 mg during hospitalization, and treatment durations exceeding 72 h were associated with improved mortality risk at all intervals. Regarding DEX efficacy at 28 days, our subgroup analyses indicated a significant interaction between the Sequential Organ Failure Assessment score and invasive mechanical ventilation.
DEX administration was associated with improved in-hospital mortality and reduced mortality rates at 7 days, 28 days, 90 days, and 1 year in patients with SIMI. These findings require validation in future studies.
右美托咪定（DEX）治疗脓毒症诱发的心肌损伤（SIMI）的疗效仍不明确。在本研究中，我们探讨了DEX的使用与SIMI患者临床结局之间的关系，重点关注剂量和治疗持续时间。
在这项回顾性队列分析中，我们从重症监护医学信息数据库IV（MIMIC-IV）中识别出SIMI患者，并根据重症监护病房治疗情况将他们分为DEX组和非DEX组。通过倾向评分匹配（PSM）减少基线偏倚。主要结局是28天死亡率，次要结局是住院死亡率以及7天、90天和1年的死亡率。使用Kaplan-Meier分析和Cox比例风险模型评估DEX使用与住院死亡率之间的关联。
经过PSM后，DEX组的373例患者与非DEX组的579例患者进行匹配，以实现协变量的均衡分布。Cox回归模型显示，使用DEX可使28天死亡率显著降低，风险比（HR）为0.61（95%置信区间[CI]：0.47-0.78，P<0.001）。住院死亡率也显著降低（HR=0.43，95%CI：0.33-0.57，P<0.001）。在7天、90天和1年时观察到较低的死亡率。DEX剂量>0.4μg/kg/h，特别是在0.400-0.612μg/kg/h范围内，住院期间总剂量>3.113mg，以及治疗持续时间超过72小时，在所有时间段均与改善死亡风险相关。关于28天时的DEX疗效，我们的亚组分析表明序贯器官衰竭评估评分与有创机械通气之间存在显著交互作用。
在SIMI患者中，使用DEX与改善住院死亡率以及降低7天、28天、90天和1年的死亡率相关。这些发现需要在未来的研究中进行验证。
