A competing risk model analysis of dexmedetomidine of in-hospital mortality in subarachnoid hemorrhage patients

Abstract

Subarachnoid hemorrhage (SAH) is a severe cerebrovascular disorder characterized by the sudden influx of blood into the subarachnoid space. The use of sedatives may be associated with the prognosis of SAH patients. We obtained SAH data from the MIMIC-IV database. The receiver operating characteristic curve, Delong test, and decision curve analysis were used to assess the predictive value of sedatives. Propensity score matching (PSM) method was applied to match samples at a 1:1 ratio. Logistic regression analysis, generalized linear regression analysis, and stratified analysis were used to investigate the association of the sedative with in-hospital mortality and length of hospital stay (LOS). Finally, a competing risk analysis was performed to evaluate the survival probability with two potential outcomes. Dexmedetomidine had a better prognosis value than Propofol and Midazolam. After PSM analysis, the Dexmedetomidine and the non-Dexmedetomidine groups had 248 samples each. The application of Dexmedetomidine reduced the risk of in-hospital mortality but might prolong the LOS. When considering in-hospital mortality as a competing risk factor for LOS, Dexmedetomidine was a protective factor for in-hospital mortality but had no significant relationship with LOS. In conclusion, treatment of Dexmedetomidine could reduce the risk of in-hospital mortality with satisfactory predictive efficiency.

Keywords: Competing risk analysis; Dexmedetomidine; In-hospital mortality; Length of hospital stay; Subarachnoid hemorrhage.

Fig. 1

Workflow of exclusion and inclusion as utilized to select the 527 patients.

Fig. 2

The assessment of the clinical value of three sedative drugs. (A) The ROC curve of three sedative drugs in predicting in-hospital death of SAH. (B) The DCA curve of three sedative drugs in predicting the death of SAH. Model1 indicated Propofol; Model2 indicated Midazolam; Model3 indicated Dexmedetomidine. SAH subarachnoid hemorrhage, ROC receiver operating characteristic curve, AUC area under the curve, DCA decision curve analysis.

Fig. 3

The in-hospital deaths of subarachnoid hemorrhage patients treated by Dexmedetomidine or not. (A) SAPS II quarter (1) (B) SAPS II quarter (2) (C) SAPS II quarter (3) (D) SAPS II quarter 4. DEX Dexmedetomidine.

Fig. 4

The LOS of subarachnoid hemorrhage patients treated by Dexmedetomidine or not. (A) SAPS II quarter (1) (B) SAPS II quarter (2) (C) SAPS II quarter (3) (D) SAPS II quarter (4) DEX Dexmedetomidine, LOS length of in-hospital stays.

Fig. 5

The analysis of the competitive risk models based on outcomes and the use of Dexmedetomidine. (A) The cumulative incidence of in-hospital mortality and discharge for all subarachnoid hemorrhage (SAH) patients. (B) The cumulative incidence of in-hospital mortality and discharge for SAH patients treated with Dexmedetomidine or not. Yes: SAH patients were treated with Dexmedetomidine; No: SAH patients were treated without Dexmedetomidine.