Huang Fengzhen, Yi Jiping, Zhou Tieqiao, Gong Xiaoxiang
Department of Neurology, The First People's Hospital of Chenzhou affiliated to the University of South China, Chenzhou, 423000, Hunan, China.
Department of Neurology, The First Affiliated Hospital of Xiangnan University, Chenzhou, 423000, Hunan, China.
Eur J Med Res. 2025 Jun 23;30(1):512. doi: 10.1186/s40001-025-02786-y.
Sepsis-associated encephalopathy (SAE), a severe neurological complication of systemic infection, carries substantial morbidity and mortality risks. This study aims to examine the relationship between early acetaminophen use and survival rates in critically ill SAE patients.
Using data from the MIMIC-IV database, we conducted a retrospective cohort study on patients with SAE, stratified by acetaminophen exposure within 48 h of ICU admission. Among the 4111 eligible patients (1689 acetaminophen recipients versus 2422 non-recipients), propensity score matching resulted in 3124 matched subjects (1562 per cohort). The primary outcome was 90-day mortality, while secondary outcomes included mortality rates at 30, 60, 180, and 365 days. Survival analyses utilized Cox proportional hazards regression and Kaplan-Meier curves, supplemented by subgroup analyses for 90-day mortality.
Acetaminophen exposure was correlated with reduced 30-day mortality rate (HR = 0.78, 95%CI [0.65-0.94], p < 0.05), as well as decreased 60-day (HR = 0.71, 95%CI [0.60-0.83], p < 0.001), 90-day (HR = 0.70, 95%CI [0.60-0.81], p < 0.001), 180-day (HR = 0.70, 95%CI [0.60-0.80], p < 0.001) and 365-day (HR = 0.69, 95%CI [0.61-0.79], p < 0.001) mortality rate after PSM. The Kaplan-Meier analysis demonstrated significantly higher survival rates in the acetaminophen group compared to the non-acetaminophen group, with a persistent trend at 30, 90, 180, and 365 days (log-rank p < 0.05). The protective effect was consistent across subgroups except acetaminophen dosage ≥ 650 mg.
Early administration of acetaminophen is associated with reduced short- and long-term mortality in SAE patients. These findings support a potential therapeutic role for acetaminophen in SAE and warrant further mechanistic and prospective validation.
脓毒症相关脑病（SAE）是全身感染的一种严重神经并发症，具有较高的发病和死亡风险。本研究旨在探讨早期使用对乙酰氨基酚与重症SAE患者生存率之间的关系。
利用多中心重症医学信息库-Ⅳ（MIMIC-IV）数据库的数据，我们对SAE患者进行了一项回顾性队列研究，根据重症监护病房（ICU）入院后48小时内是否使用对乙酰氨基酚进行分层。在4111例符合条件的患者中（1689例使用对乙酰氨基酚者与2422例未使用者），倾向得分匹配产生了3124例匹配对象（每组1562例）。主要结局为90天死亡率，次要结局包括30、60、180和365天的死亡率。生存分析采用Cox比例风险回归和Kaplan-Meier曲线，并对90天死亡率进行亚组分析。
倾向得分匹配后，使用对乙酰氨基酚与30天死亡率降低相关（风险比[HR]=0.78，95%置信区间[CI][0.65-0.94]，p<0.05），60天（HR=0.71，95%CI[0.60-0.83]，p<0.001）、90天（HR=0.70，95%CI[0.60-0.81]，p<0.001）、180天（HR=0.70，95%CI[0.60-0.80]，p<0.001）和365天（HR=0.69，95%CI[0.61-0.79]，p<0.001）死亡率也降低。Kaplan-Meier分析显示，与未使用对乙酰氨基酚组相比，使用对乙酰氨基酚组的生存率显著更高，在30、90、180和365天均呈现持续趋势（对数秩检验p<0.05）。除对乙酰氨基酚剂量≥650mg的亚组外，保护作用在各亚组中均一致。
早期使用对乙酰氨基酚与SAE患者短期和长期死亡率降低相关。这些发现支持对乙酰氨基酚在SAE中具有潜在治疗作用，值得进一步进行机制和前瞻性验证。
