Dexmedetomidine for Reducing Mortality in Patients with Sepsis and Concomitant Heart Failure: A Retrospective Cohort...

ObjectiveAlthough dexmedetomidine (DEX) is commonly used in sepsis management, its effect on prognosis in patients with concomitant heart failure (HF) remains controversial. This study aims to examine the association between DEX use and 30-day mortality in this population.MethodsThis retrospective cohort study identified patients meeting Sepsis-3.0 criteria with comorbid HF from the MIMIC-IV database. Subjects were stratified into DEX and non-DEX groups according to intensive care unit (ICU) medication records. Propensity score matching (PSM) was applied to balance baseline characteristics and reduce confounding. Primary and secondary outcomes were 30-day and 90-day mortality, respectively. Logistic regression and Kaplan-Meier analyses were used to assess the association of DEX use, dosage, and administration duration with patient prognosis.ResultsAfter PSM, 1331 patients were divided into a DEX group and a non-DEX group, with balanced baseline characteristics. Multivariable-adjusted logistic regression showed that no association was observed between DEX use and 30-day mortality (OR = 0.861, 95% CI: 0.702-1.056, P = .151). However, DEX administration within the first 24 h was associated with a lower 30-day mortality rate (OR = 0.742, 95% CI: 0.588-0.932, P = .011). A low dose of DEX (<399.983mcg) was associated with a lower 30-day mortality rate (OR = 0.697, 95% CI: 0.527-0.913, P = .010), whereas no association was noted for a medium dose (399.983-2472.306mcg) or a high dose (>2472.306mcg).ConclusionIn this cohort, DEX use was not associated with a lowered 30-day or 90-day mortality rate among patients with sepsis and concomitant HF. Nevertheless, shorter exposure to DEX (in terms of dose and duration) may be associated with ameliorated outcomes.