Associations of propofol and midazolam with the 30-day mortality in patients with sepsis-associated encephalopathy: A study of the MIMIC database.

IF 2.1 4区医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL

Advances in Clinical and Experimental Medicine Pub Date : 2025-04-24 DOI:10.17219/acem/196102

Lanfen Zhan, Xinyao Xiang, Yu Zhang, Lingmin Zhou

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引用次数: 0

Abstract

Background: Propofol and midazolam have been widely used in patients with sepsis. However, the effectiveness of these drugs in reducing the duration of mechanical ventilation and the risk of mortality remains controversial.

Objectives: To investigate and compare effects of propofol and midazolam on 30-day mortality in patients with sepsis-associated encephalopathy (SAE).

Material and methods: A retrospective cohort study was conducted on data from 952 adult patients with SAE extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Univariable and multivariable Cox proportional hazard models were utilized to investigate the associations of propofol and midazolam with 30-day mortality; and univariable and multivariable logistic regression analyses were used to explore the relationships of propofol and midazolam with ventilation duration. The outcome measures were hazard ratios (HRs), odds ratios (ORs), and 95% confidence intervals (95% CIs). In addition, subgroup analyses of age, simplified acute physiological score (SAPS)-II, Charlson Comorbidity Index (CCI), and ventilation duration were also performed to further assess the associations of propofol and midazolam with 30-day mortality.

Results: Among eligible patients, 265 (27.84%) died within 30 days. After adjusting for covariates, treatment with propofol was associated with both lower risk of 30-day mortality (HR = 0.67, 95% CI: 0.51-0.88) and lower odds of prolonged ventilation duration (OR = 0.71, 95% CI: 0.53-0.96) compared to treatment with midazolam. Moreover, the negative association between treatment with propofol and 30-day mortality was also significant in subgroups of age ≥65 years, SAPS-II score ≥47, CCI score ≥3, and ventilation duration ≥5 days (all p < 0.05).

Conclusions: Among patients with SAE, treatment with propofol was relatively more effective than treatment with midazolam in reducing the risk of 30-day mortality and the duration of mechanical ventilation. However, the causal relationships of propofol and midazolam with prognosis in patients with SAE need further clarification.

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异丙酚和咪达唑仑与败血症相关脑病患者30天死亡率的关系：MIMIC数据库的研究

背景：异丙酚和咪达唑仑已广泛应用于脓毒症患者。然而，这些药物在减少机械通气持续时间和死亡风险方面的有效性仍然存在争议。目的：研究并比较异丙酚和咪达唑仑对脓毒症相关脑病（SAE）患者30天死亡率的影响。材料和方法：一项回顾性队列研究从重症监护医学信息市场（MIMIC-IV）数据库中提取了952例SAE成年患者的数据。采用单变量和多变量Cox比例风险模型探讨异丙酚和咪达唑仑与30天死亡率的关系；采用单变量和多变量logistic回归分析探讨异丙酚、咪达唑仑与通气时间的关系。结果测量指标为风险比（hr）、优势比（ORs）和95%置信区间（95% ci）。此外，还进行了年龄、简化急性生理评分(SAPS)-II、Charlson共病指数（CCI）和通气时间的亚组分析，以进一步评估异丙酚和咪达唑仑与30天死亡率的关系。结果：符合条件的患者中，265例（27.84%）在30天内死亡。校正协变量后，与咪达唑仑治疗相比，异丙酚治疗与30天死亡率风险（HR = 0.67, 95% CI: 0.51-0.88）和延长通气时间的几率（OR = 0.71, 95% CI: 0.53-0.96）均较低相关。此外，在年龄≥65岁、sap - ii评分≥47、CCI评分≥3、通气时间≥5天的亚组中，异丙酚治疗与30天死亡率之间也存在显著负相关（均p < 0.05）。结论：在SAE患者中，异丙酚治疗比咪达唑仑治疗在降低30天死亡风险和机械通气持续时间方面相对更有效。然而，异丙酚和咪达唑仑与SAE患者预后的因果关系需要进一步澄清。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Advances in Clinical and Experimental Medicine MEDICINE, RESEARCH & EXPERIMENTAL-

CiteScore

3.70

自引率

4.80%

发文量

153

审稿时长

6-12 weeks

期刊介绍： Advances in Clinical and Experimental Medicine has been published by the Wroclaw Medical University since 1992. Establishing the medical journal was the idea of Prof. Bogumił Halawa, Chair of the Department of Cardiology, and was fully supported by the Rector of Wroclaw Medical University, Prof. Zbigniew Knapik. Prof. Halawa was also the first editor-in-chief, between 1992-1997. The journal, then entitled "Postępy Medycyny Klinicznej i Doświadczalnej", appeared quarterly. Prof. Leszek Paradowski was editor-in-chief from 1997-1999. In 1998 he initiated alterations in the profile and cover design of the journal which were accepted by the Editorial Board. The title was changed to Advances in Clinical and Experimental Medicine. Articles in English were welcomed. A number of outstanding representatives of medical science from Poland and abroad were invited to participate in the newly established International Editorial Staff. Prof. Antonina Harłozińska-Szmyrka was editor-in-chief in years 2000-2005, in years 2006-2007 once again prof. Leszek Paradowski and prof. Maria Podolak-Dawidziak was editor-in-chief in years 2008-2016. Since 2017 the editor-in chief is prof. Maciej Bagłaj. Since July 2005, original papers have been published only in English. Case reports are no longer accepted. The manuscripts are reviewed by two independent reviewers and a statistical reviewer, and English texts are proofread by a native speaker. The journal has been indexed in several databases: Scopus, Ulrich’sTM International Periodicals Directory, Index Copernicus and since 2007 in Thomson Reuters databases: Science Citation Index Expanded i Journal Citation Reports/Science Edition. In 2010 the journal obtained Impact Factor which is now 1.179 pts. Articles published in the journal are worth 15 points among Polish journals according to the Polish Committee for Scientific Research and 169.43 points according to the Index Copernicus. Since November 7, 2012, Advances in Clinical and Experimental Medicine has been indexed and included in National Library of Medicine’s MEDLINE database. English abstracts printed in the journal are included and searchable using PubMed http://www.ncbi.nlm.nih.gov/pubmed.