Dexmedetomidine is Associated with Reduced In-Hospital Mortality Risk of Patients with Subarachnoid Hemorrhage Undergoing Surgery.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.