Association between anesthetic administration and mortality in patients with hemorrhagic stroke: Analysis of the MIMIC-IV database

Abstract

Objective

Anesthetic drugs are used in patients with hemorrhagic stroke (HS). We explored the impact of anesthetics on in-hospital mortality in patients with HS using the Medical Information Mart for Intensive Care IV (MIMIC-IV) database.

Methods

Eligible patients with HS who were treated between 2008 and 2019 were selected from the MIMIC-IV (version 3.1) database. The Chi-squared test and Wilcoxon’s test were performed to compare the differences between deceased and surviving patients. Then, least absolute shrinkage and selection operator and multivariate logistic regression analyses were employed to identify variables associated with mortality, after which a nomogram was constructed to predict in-hospital mortality. The performance of this nomogram was assessed by receiver operating characteristic curve analysis.

Results

In total, 1541 patients were included, including 270 deceased patients (17.5 %) and 1271 surviving patients (82.5 %). Meanwhile, 970 (62.9 %) patients received anesthetics. The use of rocuronium (regression coefficient [β] = 1.033; odds ratio [OR] = 2.809; 95 % confidence interval [CI] = 1.054–7.357; P = 0.037) or morphine (β = 1.894; OR = 6.644; 95 % CI = 4.443–10.079; P < 0.001) was identified as a risk factor for in-hospital mortality in patients with HS. A nomogram was constructed using the statistically significant variables, and its area under curve was 0.924, indicating its high predictive accuracy for in-hospital mortality.

Conclusion

A significant percentage of patients with HS received anesthetics. The use of rocuronium and morphine was associated with an increased mortality risk. A nomogram including anesthetic administration could accurately predict in-hospital mortality in patients with HS.