The impact of ketamine on ICU mortality in patients with sepsis: A retrospective cohort study

Sepsis represents a systemic inflammatory response syndrome triggered by infection, potentially resulting in critical organ dysfunction with life-threatening consequences. Ketamine demonstrates efficacy in suppressing the release of inflammatory factors, thereby contributing significantly to the mitigation of inflammatory response of patients with sepsis while preserving vital organ functionality.

This study aims to examine the effect of ketamine administration on the ICU mortality rate of patients with sepsis.

This retrospective analysis utilized data from the MIMIC-IV database (n = 25,252 ICU patients). Primary outcomes were 7-day and 14-day ICU mortality rates, while secondary outcomes included ICU and total hospital length of stay. Covariates were adjusted using propensity score matching (PSM), and statistical analysis was performed using R software.

After PSM, the analysis cohort included 2612 patients. Ketamine administration was significantly associated with reduced 7-day ICU mortality (HRs: 0.65 [0.48, 0.89], 0.63 [0.46, 0.86], 0.62 [0.45, 0.85]; all P < 0.05). No significant differences were observed in 14-day mortality. ICU and total hospital stays were longer in the ketamine group.

In this retrospective cohort, ketamine exposure was associated with lower 7-day ICU mortality; however, residual confounding and heterogeneity in timing, dose, and indication for ketamine use cannot be excluded. The longer hospital and ICU stays observed in ketamine-treated patients further underscore the need for prospective trials to clarify efficacy, optimal timing, and safety before routine adoption.