Early acetaminophen administration is associated with lower mortality among ARDS patients after coronary artery bypass grafting: a retrospective study

Abstract

Background: Acetaminophen (APAP) is widely used in the treatment of patients after surgery, but the prognosis of patients with coronary artery bypass grafting (CABG)-related acute respiratory distress syndrome (CABG-ARDS) is still unclear. This study aims to explore the role of APAP in the management of CABG related ARDS.

Methods: We collected clinical data on patients with CABG-ARDS from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. The primary outcome was early mortality after ARDS, and the secondary outcomes were length of hospital stay and duration of mechanical ventilation (MV). Multivariate logistic regression and Cox regression models were used for statistical analysis, and inverse probability processing weighting (IPTW), overlap weighting (OW) and propensity score matching (PSM) were used to explore the robustness of the outcomes.

Results: A total of 5459 patients were enrolled in the analysis. Multivariate logistic regression analysis revealed that the 14-day mortality in APAP group was significantly lower than that in non-APAP group (0.5% vs. 2.7%, OR = 0.301; 95% CI, 0.170-0.531; P < 0.001). The APAP group also showed a significant advantage in Cox regression analysis (0.5% vs. 2.7%, HR = 0.329; 95% CI, 0.187-0.577; P < 0.001). IPTW, OW, and PSM analyses were conducted between the two groups, and the differences remained significant. These results were consistent in 30-, 60-, and 90-day mortality analyses. Meanwhile, exposure to APAP was associated with a shorter length of hospital stay and a reduced duration of MV (P < 0.001).

Conclusion: The administration of APAP was associated with reduced early mortality in patients with CABG-ARDS, as well as shorter length of hospital stay and duration of MV.

Keywords: Acetaminophen; Acute respiratory distress syndrome; Coronary artery bypass grafting; MIMIC-IV; Mortality.

Fig. 1

Study flow chart MIMIC-IV, medical information mart for intensive care-IV; CABG, coronary artery bypass grafting; ICU, intensive care unit; ARDS, acute respiratory distress syndrome

Fig. 2

Kaplan-Meier (K-M) survival analysis curve. (A) 14-day K-M survival curves; (B) 30-day K-M survival curves; (C) 60-day K-M survival curves; (D) 90-day K-M survival curves APAP, acetaminophen

Fig. 3

Comparative analysis of mortality in CABG-ARDS patients across five statistical models. Comparison of 14-, 30-, 60-, and 90-day mortality in the APAP and non-APAP groups of CABG-ARDS patients by five statistical methods, multivariate logistic regression, multivariate Cox regression, IPTW, OW and PSM HR, hazard ratio; OR, odds ratio; CI, confidence interval; IPTW, inverse probability of treatment weighting; OW, overlap weighting; PSM, propensity score matching; APAP, acetaminophen; CABG, coronary artery bypass grafting; ARDS, acute respiratory distress syndrome

Fig. 4

E-value for mortality association in APAP-treated CABG-ARDS patients. E-value for the lower 95% CI and point estimation in 14-day mortality (A), 30-day mortality (B), 60-day mortality (C), and 90-day mortality (D) of CABG-ARDS patients CI, confidence interval; CABG, coronary artery bypass grafting; ARDS, acute respiratory distress syndrome

Fig. 5

Subgroup analyses. Early use of APAP was associated with 14-, 30-day mortality (A) and 60-, 90-day mortality (B) in CABG-ARDS patients HR, hazard ratio; CI, confidence interval; BMI, body mass index; ARDS, acute respiratory distress syndrome; SOFA, sequential organ failure assessment; APAP, acetaminophen; CABG, coronary artery bypass grafting