Dexmedetomidine Use and Short-Term All-Cause Mortality in Intensive Care Unit Patients with Ischemic Stroke and Atrial Fibrillation: A Propensity-Matched Analysis from MIMIC-IV.

Abstract

Introduction: Preclinical studies have demonstrated that dexmedetomidine (DEX), a sedative widely used in intensive care units (ICU), exerts neuroprotective effects. However, its potential protective role and underlying mechanisms in ischemic stroke patients with atrial fibrillation (IS-AF) remain unclear. The study's objective was to assess the connection between the early administration of DEX and short-term mortality from all causes in patients with IS-AF.

Methods: From the MIMIC-IV database, patients with IS-AF were identified, including those who were administered DEX and those who were not. The primary endpoint was 7-day all-cause mortality, and the secondary endpoint was 90-day all-cause mortality. Propensity score matching (PSM) was utilized to ensure baseline covariates were balanced. Cox proportional hazards models and Kaplan-Meier survival curves and were utilized to evaluate the association between DEX use and mortality, with subgroup analyses conducted to ensure the findings' robustness.

Results: In total, 1,355 patients with IS-AF participated, with 253 (18.7%) receiving DEX. After PSM, 208 pairs were matched. In the fully adjusted model, DEX administration was significantly associated with lower all-cause mortality compared with the control group at both 7 days (before PSM, HR = 0.36, 95% CI: 0.19-0.68, p = 0.002; after PSM, HR = 0.26, 95% CI: 0.12-0.54, p < 0.001) and 90 days (before PSM, HR = 0.84, 95% CI: 0.66-1.07, p = 0.162; after PSM, HR = 0.72, 95% CI: 0.53-0.97, p = 0.031). The subgroup analyses revealed that DEX's protective effect was stronger in patients aged 70 and above, females, those with hypertension, and those without heart failure or chronic kidney disease. Kaplan-Meier survival curves consistently illustrated that DEX users had greater survival probabilities both before and after matching.

Conclusion: In patients with IS-AF, DEX administration is connected to decreased all-cause mortality mortality, underlining the possible importance of DEX in ICU settings.