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. 2025 Jul 5;15(7):e101395.
doi: 10.1136/bmjopen-2025-101395.

Association between dexmedetomidine sedation and mortality in critically ill patients with ischaemic stroke: a retrospective study based on MIMIC-IV database

Yuecheng Yang #  1   2 , Jingying Zhang #  2   3 , Haoyuan Wang #  1   2 , Yunkui Zhang  1   2 , Jun Zhang  4   2
Affiliations

Association between dexmedetomidine sedation and mortality in critically ill patients with ischaemic stroke: a retrospective study based on MIMIC-IV database

Yuecheng Yang et al. BMJ Open. .

Abstract

Objective: This study investigates the effects of dexmedetomidine on short-term and long-term survival rates in intensive care unit (ICU) patients with ischaemic stroke.

Design: This is a retrospective study.

Setting: Data were sourced from the Medical Information Mart for Intensive Care IV database.

Participants: This study analysed 2816 patients with ischaemic stroke from the US Intensive Care database.

Interventions: Dexmedetomidine administration during the ICU stay was defined as the exposure.

Methods: Patients were categorised into the dexmedetomidine group and the control group. Cox regression analysis was used to identify factors that may influence the 28-day mortality rate of patients with ischaemic stroke. High-risk factors were incorporated as covariates, and a 1:1 propensity score matching using the logit model was constructed to compare the prognosis between the two groups.

Primary and secondary outcome measures: The primary outcome was 28-day mortality. The secondary outcomes included in-hospital mortality, ICU length of stay, hospital length of stay, mechanical ventilation duration and 180-day mortality in discharged patients.

Results: A total of 2816 patients were included. Cox regression analysis revealed that dexmedetomidine use was associated with a reduced risk of 28-day mortality. Following propensity score matching, each group comprised 407 patients. Dexmedetomidine was found to improve 28-day mortality (27.8% vs 36.6%, p=0.007). However, it was also associated with the prolonged length of hospital and ICU stay (p=0.002). Among discharged patients, dexmedetomidine use was also associated with an improved 180-day mortality rate (p=0.0019).

Conclusion: The use of dexmedetomidine is associated with improved short-term and long-term prognosis in patients with ischaemic stroke and could potentially confer benefits in those receiving mechanical ventilation.

Keywords: ANAESTHETICS; Intensive Care Units; Mortality; Stroke.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1. The flowchart of the study. ICU, intensive care unit; MIMIC, Medical Information Mart for Intensive Care; PSM, propensity score matching.
Figure 2
Figure 2. The Kaplan-Meier (KM) curves after propensity score matching (PSM). (A) KM curves for 28-day mortality between the dexmedetomidine group and the control group after PSM. (B) KM curve for 180-day mortality rate of discharged patients after PSM.
Figure 3
Figure 3. Subgroup analysis of the 180-day mortality rate among discharged patients after propensity score matching. After propensity score matching, the risk of 180-day mortality for each subgroup was represented by the relative risk (95% CI). A relative risk and CI range to the left of one suggest a benefit in 180-day mortality associated with dexmedetomidine use in the specific subgroup of patients with ischaemic stroke. AF, atrial fibrillation; GCS, Glasgow Coma Scale; RR, relative risk.
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