Dexmedetomidine Use and Reduced In-hospital Mortality in ICU Patients with Delirium: A Retrospective Study Based on Two Observational Cohorts

Abstract

Objective

Dexmedetomidine has been reported to reduce the emergence and persistence of delirium among critically ill patients, but whether it has a survival benefit in these delirium patients remains unclear. The current study aimed to investigate the link between the use of dexmedetomidine during intensive care units (ICU) admission and mortality outcomes in critically ill individuals with delirium.

Materials and Methods

Data from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) and the eICU Collaborative Research Database (eICU-CRD) were used to conduct this retrospective cohort study. Adult ICU patients experiencing delirium were included. Exposure was defined as the use of dexmedetomidine during ICU stay. Covariates included demographics, clinical variables, illness severity scores, interventions in the first 24 h, and comorbidities. Associations between dexmedetomidine use and in-hospital mortality were analyzed using generalized linear models and propensity score methods.

Results

Patients receiving dexmedetomidine had significantly lower in-hospital mortality rates compared to those not treated, with 17.55% versus 32.67% in the MIMIC-IV cohort and 7.41% versus 7.81% in the eICU-CRD cohort. After adjustment, dexmedetomidine use was associated with reduced in-hospital mortality (MIMIC-IV: OR 0.40, 95% CI 0.28-0.58, P < 0.0001; eICU-CRD: OR 0.55, 95% CI 0.46-0.67, P < 0.0001). Propensity score analyses confirmed these findings. Furthermore, mortality at 90 days, 180 days, and 1 year was also significantly reduced in the dexmedetomidine group.

Conclusions

Dexmedetomidine administration during ICU stay correlates with a reduced mortality risk in critically ill patients suffering from delirium.