Jones James Harvey, Fleming Susannah
Department of Anesthesiology, University of North Carolina at Chapel Hill, N2198 UNC Hospitals, CB #7010, Chapel Hill, NC 27599-7010, USA.
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Ther Adv Drug Saf. 2025 Aug 20;16:20420986251367509. doi: 10.1177/20420986251367509. eCollection 2025.
Dexmedetomidine may expedite recovery from acute kidney injury (AKI) in critically ill adults.
This study utilizes data from the fourth edition of the Medical Information Mart for Intensive Care (MIMIC-IV). Adult patients admitted to Beth Israel Deaconess Medical Center in Boston, Massachusetts, between 2008 and 2019 with AKI and who have at least two serum creatinine values recorded in the MIMIC-IV database meet study inclusion criteria. The primary outcome measure is the time (days) from diagnosis of AKI to recovery. Secondary outcome measures are hospital and ICU length of stay (LOS) as well as in-hospital mortality.
A total of 1893 patients are included in this study. While 293 patients received dexmedetomidine, 1600 patients did not receive dexmedetomidine. Treatment with dexmedetomidine is associated with a 53.7% (95% CI: 46.8%-59.8%) decrease in the risk of recovery from AKI, on average, and this value is statistically significant ( < 0.001). Sensitivity analysis utilizing Cox regression of dexmedetomidine rate on time to AKI recovery demonstrated the opposite effect, however, with an adjusted HR of 1.42 (95% CI: 1.24-1.63, value <0.001). Theories for this opposite effect are explored in the Discussion section of the manuscript. For patients who receive dexmedetomidine, hospital and ICU LOS, on average, increase by 18.98% and 32.56%, respectively ( value <0.001). Patients who receive dexmedetomidine have 0.6 times the odds of in-hospital mortality, on average, compared to patients who do not receive dexmedetomidine, which is statistically significant ( value 0.006).
Dexmedetomidine may be associated with slower recovery from AKI in critically ill adults. The prolonged hospital and ICU LOS associated with dexmedetomidine may be related to reduced mortality, but these results require additional investigation. These exploratory results warrant further investigation to better understand the clinical implications of dexmedetomidine exposure in the setting of AKI.
右美托咪定可能会加速重症成年患者急性肾损伤（AKI）的恢复。
本研究利用重症监护医学信息集市（MIMIC-IV）第四版中的数据。2008年至2019年间，入住马萨诸塞州波士顿贝斯以色列女执事医疗中心且患有AKI并在MIMIC-IV数据库中记录了至少两个血清肌酐值的成年患者符合研究纳入标准。主要结局指标是从AKI诊断到恢复的时间（天）。次要结局指标是住院时间和重症监护病房（ICU）住院时长（LOS）以及院内死亡率。
本研究共纳入1893例患者。其中293例患者接受了右美托咪定治疗，1600例患者未接受右美托咪定治疗。右美托咪定治疗平均使AKI恢复风险降低53.7%（95%置信区间：46.8%-59.8%），且该值具有统计学意义（<0.001）。然而，利用Cox回归分析右美托咪定使用率对AKI恢复时间的敏感性分析显示出相反的效果，校正后的风险比为1.42（95%置信区间：1.24-1.63，<0.001）。本文讨论部分探讨了这种相反效果的原因。对于接受右美托咪定治疗的患者，住院时间和ICU住院时长平均分别增加18.98%和32.56%（<0.001）。与未接受右美托咪定治疗的患者相比，接受右美托咪定治疗的患者院内死亡几率平均为其0.6倍，具有统计学意义（=0.006）。
右美托咪定可能与重症成年患者AKI恢复较慢有关。与右美托咪定相关的住院时间和ICU住院时长延长可能与死亡率降低有关，但这些结果需要进一步研究。这些探索性结果值得进一步研究，以更好地了解在AKI情况下使用右美托咪定的临床意义。
