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Association between Milrinone Use and Mortality Risk in Sepsis: Insights from the MIMIC-IV Database
Jiali Wu1, Cong Liu1, Xiaojing Ji2
1Department of Emergency, General Hospital of Ningxia Medical University, Yinchuan, China.
Shock (Augusta, Ga.)
|July 20, 2026
Summary
Milrinone administration may reduce mortality in sepsis patients, particularly those with heart failure. Further research is needed to confirm its role and optimal dosing in sepsis management.
Area of Science:
- Critical Care Medicine
- Pharmacology
- Epidemiology
Background:
- Milrinone is a key treatment for heart failure.
- Its effectiveness in sepsis patients is not well-established.
- This study investigates milrinone's impact on sepsis mortality.
Purpose of the Study:
- To determine the association between milrinone use and mortality in sepsis patients.
- To explore potential dose-dependent effects and interactions with heart failure.
Main Methods:
- Retrospective cohort study using MIMIC-IV data.
- Propensity score matching and IPTW for bias reduction.
- Multivariate Cox models, RCS curves, and TMLE for mortality analysis.
Main Results:
- Milrinone use was linked to decreased 7-, 14-, and 28-day mortality in unadjusted and adjusted analyses.
- A significant association with reduced 28-day mortality persisted after IPTW.
- TMLE indicated protective effects for 14- and 28-day mortality.
- Reduced mortality was observed only in sepsis patients with heart failure.
Conclusions:
- Milrinone use shows a potential association with reduced mortality in sepsis patients.
- The relationship appears linear for 7-day mortality and nonlinear for 14- and 28-day mortality.
- Milrinone's benefit in sepsis may be specific to patients with comorbid heart failure.