Piao Zhi-Sheng, Zhang Yu-Jia, Li Gen, Jia Yi, Cheng Kun
Department of Critical Care Medicine, Eastern Hepatobiliary Surgery Hospital Affiliated to Naval Medical University, Shanghai, China.
Department of Emergency, Eastern Hepatobiliary Surgery Hospital Affiliated to Naval Medical University, Shanghai, China.
Front Pharmacol. 2025 Jul 24;16:1622440. doi: 10.3389/fphar.2025.1622440. eCollection 2025.
The impact of acetaminophen on the prognosis of ischemic stroke patients admitted to intensive care units remains unclear. Although acetaminophen is commonly used for fever and pain management, its potential benefits beyond temperature control require further investigation.
Using the MIMIC-IV database, we retrospectively identified 494 ICU-admitted ischemic stroke patients, of whom 362 (73.28%) received early acetaminophen treatment within 48 h after ICU admission. Patients were stratified based on acetaminophen exposure. Weighted Cox regression was applied after inverse probability of treatment weighting (IPTW) adjustment. Subgroup and sensitivity analyses were performed to assess the consistency of associations.
After IPTW adjustment, early acetaminophen use was associated with reduced 30-day mortality (HR 0.54, 95% CI 0.31-0.94, p = 0.030), and reduced 90-day mortality (HR 0.53, 95% CI 0.32-0.87, p = 0.013). There were no significant differences in in-hospital mortality or hospital length of stay. Subgroup analyses revealed no significant interaction effects, suggesting a consistent association across different clinical strata.
Early acetaminophen use may be associated with improved survival outcomes in critically ill ischemic stroke patients. These findings highlight the potential therapeutic value of acetaminophen beyond symptomatic treatment, warranting confirmation through prospective, multicenter randomized controlled trials.
对乙酰氨基酚对入住重症监护病房的缺血性中风患者预后的影响尚不清楚。尽管对乙酰氨基酚常用于发热和疼痛管理，但其在控制体温之外的潜在益处仍需进一步研究。
利用MIMIC-IV数据库，我们回顾性识别了494名入住重症监护病房的缺血性中风患者，其中362名（73.28%）在入住重症监护病房后48小时内接受了早期对乙酰氨基酚治疗。根据对乙酰氨基酚暴露情况对患者进行分层。在进行治疗权重逆概率（IPTW）调整后应用加权Cox回归。进行亚组分析和敏感性分析以评估关联的一致性。
经过IPTW调整后，早期使用对乙酰氨基酚与30天死亡率降低相关（风险比0.54，95%置信区间0.31-0.94，p = 0.030），以及90天死亡率降低相关（风险比0.53，95%置信区间0.32-0.87，p = 0.013）。住院死亡率或住院时间没有显著差异。亚组分析显示没有显著的交互作用，表明在不同临床分层中存在一致的关联。
早期使用对乙酰氨基酚可能与重症缺血性中风患者的生存结局改善相关。这些发现突出了对乙酰氨基酚在对症治疗之外的潜在治疗价值，需要通过前瞻性、多中心随机对照试验加以证实。
