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Peer-reviewedCC BYEuropean neurology

Dexmedetomidine Use and Short-Term All-Cause Mortality in Intensive Care Unit Patients with Ischemic Stroke and Atrial Fibrillation: A Propensity-Matched Analysis from MIMIC-IV.

  • Zengyan Bai1
  • Ke Shi2
  • Hongwei Liu3
  • Zhinan Ye4
  • Suqian Xu5
5 affiliations
  1. 1Department of Critical Care Medicine, Taiyuan City Central Hospital, The Ninth Clinical Medical College of Shanxi Medical University, Taiyuan, China.
  2. 2Department of Neurology, Xiangshui County People's Hospital, Yancheng, China.
  3. 3Department of Neurology, Taiyuan City Central Hospital, The Ninth Clinical Medical College of Shanxi Medical University, Taiyuan, China.
  4. 4Department of Neurology, Taizhou Municipal Hospital (Taizhou University Affiliated Municipal Hospital), School of Medicine, Taizhou University, Taizhou, China.
  5. 5Department of Neurology, Taizhou Municipal Hospital (Taizhou University Affiliated Municipal Hospital), School of Medicine, Taizhou University, Taizhou, China, [email protected].
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Abstract

Introduction

Preclinical studies have demonstrated that dexmedetomidine (DEX), a sedative widely used in intensive care units (ICU), exerts neuroprotective effects. However, its potential protective role and underlying mechanisms in ischemic stroke patients with atrial fibrillation (IS-AF) remain unclear. The study's objective was to assess the connection between the early administration of DEX and short-term mortality from all causes in patients with IS-AF.Methods

From the MIMIC-IV database, patients with IS-AF were identified, including those who were administered DEX and those who were not. The primary endpoint was 7-day all-cause mortality, and the secondary endpoint was 90-day all-cause mortality. Propensity score matching (PSM) was utilized to ensure baseline covariates were balanced. Cox proportional hazards models and Kaplan-Meier survival curves and were utilized to evaluate the association between DEX use and mortality, with subgroup analyses conducted to ensure the findings' robustness.Results

In total, 1,355 patients with IS-AF participated, with 253 (18.7%) receiving DEX. After PSM, 208 pairs were matched. In the fully adjusted model, DEX administration was significantly associated with lower all-cause mortality compared with the control group at both 7 days (before PSM, HR = 0.36, 95% CI: 0.19-0.68, p = 0.002; after PSM, HR = 0.26, 95% CI: 0.12-0.54, p < 0.001) and 90 days (before PSM, HR = 0.84, 95% CI: 0.66-1.07, p = 0.162; after PSM, HR = 0.72, 95% CI: 0.53-0.97, p = 0.031). The subgroup analyses revealed that DEX's protective effect was stronger in patients aged 70 and above, females, those with hypertension, and those without heart failure or chronic kidney disease. Kaplan-Meier survival curves consistently illustrated that DEX users had greater survival probabilities both before and after matching.Conclusion

In patients with IS-AF, DEX administration is connected to decreased all-cause mortality mortality, underlining the possible importance of DEX in ICU settings.

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Cite

BibTeXRIS
BibTeX
@article{bai2026dexmedetomidine,
  title = {{Dexmedetomidine Use and Short-Term All-Cause Mortality in Intensive Care Unit Patients with Ischemic Stroke and Atrial Fibrillation: A Propensity-Matched Analysis from MIMIC-IV.}},
  author = {Zengyan Bai and Ke Shi and Hongwei Liu and Zhinan Ye and Suqian Xu},
  journal = {European neurology},
  year = {2026},
  month = oct,
  doi = {10.1159/ene/acsag008},
  url = {https://europepmc.org/article/MED/42879346},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Dexmedetomidine Use and Short-Term All-Cause Mortality in Intensive Care Unit Patients with Ischemic Stroke and Atrial Fibrillation: A Propensity-Matched Analysis from MIMIC-IV.
AU  - Zengyan Bai
AU  - Ke Shi
AU  - Hongwei Liu
AU  - Zhinan Ye
AU  - Suqian Xu
PY  - 2026
DA  - 2026/10/15
JO  - European neurology
DO  - 10.1159/ene/acsag008
UR  - https://europepmc.org/article/MED/42879346
AB  - Introduction  Preclinical studies have demonstrated that dexmedetomidine (DEX), a sedative widely used in intensive care units (ICU), exerts neuroprotective effects. However, its potential protective role and underlying mechanisms in ischemic stroke patients with atrial fibrillation (IS-AF) remain unclear. The study's objective was to assess the connection between the early administration of DEX and short-term mortality from all causes in patients with IS-AF.Methods  From the MIMIC-IV database, patients with IS-AF were identified, including those who were administered DEX and those who were not. The primary endpoint was 7-day all-cause mortality, and the secondary endpoint was 90-day all-cause mortality. Propensity score matching (PSM) was utilized to ensure baseline covariates were balanced. Cox proportional hazards models and Kaplan-Meier survival curves and were utilized to evaluate the association between DEX use and mortality, with subgroup analyses conducted to ensure the findings' robustness.Results  In total, 1,355 patients with IS-AF participated, with 253 (18.7%) receiving DEX. After PSM, 208 pairs were matched. In the fully adjusted model, DEX administration was significantly associated with lower all-cause mortality compared with the control group at both 7 days (before PSM, HR = 0.36, 95% CI: 0.19-0.68, p = 0.002; after PSM, HR = 0.26, 95% CI: 0.12-0.54, p < 0.001) and 90 days (before PSM, HR = 0.84, 95% CI: 0.66-1.07, p = 0.162; after PSM, HR = 0.72, 95% CI: 0.53-0.97, p = 0.031). The subgroup analyses revealed that DEX's protective effect was stronger in patients aged 70 and above, females, those with hypertension, and those without heart failure or chronic kidney disease. Kaplan-Meier survival curves consistently illustrated that DEX users had greater survival probabilities both before and after matching.Conclusion  In patients with IS-AF, DEX administration is connected to decreased all-cause mortality mortality, underlining the possible importance of DEX in ICU settings.
SN  - 0014-3022
SN  - 1421-9913
ER  -