Delirium as a mediating factor in the survival benefits of dexmedetomidine in acute brain injury management
Abstract Acute brain injury (ABI) is a leading cause of ICU admission and mortality. Effective sedation is essential for preventing secondary brain injury, and dexmedetomidine has emerged as a potential neuroprotective agent. We conducted a retrospective analysis using the MIMIC-IV v3.1 database, in...
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Nature Portfolio
2025-08-01
|
| Series: | Scientific Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1038/s41598-025-14180-z |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849226373888999424 |
|---|---|
| author | Juan Wang Jia-qing Sun Yue Lu Qi-lin Yang Peng-lai Zhao Chun-Hua Hang Wei Li |
| author_facet | Juan Wang Jia-qing Sun Yue Lu Qi-lin Yang Peng-lai Zhao Chun-Hua Hang Wei Li |
| author_sort | Juan Wang |
| collection | DOAJ |
| description | Abstract Acute brain injury (ABI) is a leading cause of ICU admission and mortality. Effective sedation is essential for preventing secondary brain injury, and dexmedetomidine has emerged as a potential neuroprotective agent. We conducted a retrospective analysis using the MIMIC-IV v3.1 database, including adult patients admitted to the ICU with ABI. Patients were divided into two groups based on whether they received dexmedetomidine. Propensity score matching (PSM), weighting methods, and doubly robust estimation were used to adjust for confounding factors. Results from the doubly robust analysis showed that dexmedetomidine use was significantly associated with reduced in-hospital mortality (HR: 0.41, 95% CI: 0.35–0.48, p < 0.001) and ICU mortality (HR: 0.34, 95% CI: 0.28–0.41, p < 0.001). Additionally, dexmedetomidine was associated with significantly increased vasopressor-free days (MD: 2.64, 95% CI: 1.98–3.30, p < 0.001) and ventilation-free days (MD: 2.23, 95% CI: 1.59–2.86, p < 0.001). Further mediation analysis indicated that delirium mediated 37% of the effect of dexmedetomidine on in-hospital mortality and 60% of its effect on ICU mortality. This suggests that delirium may be a key mediator of dexmedetomidine’s beneficial effects, consistent with its potential advantages in sedation and neuroprotection observed in previous studies. In conclusion, dexmedetomidine use in ICU patients with ABI is associated with significantly lower mortality and improved clinical outcomes, with delirium acting as a critical mediator. |
| format | Article |
| id | doaj-art-b084aa5c2de344d29b037628e11fc35d |
| institution | Kabale University |
| issn | 2045-2322 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj-art-b084aa5c2de344d29b037628e11fc35d2025-08-24T11:24:24ZengNature PortfolioScientific Reports2045-23222025-08-0115111010.1038/s41598-025-14180-zDelirium as a mediating factor in the survival benefits of dexmedetomidine in acute brain injury managementJuan Wang0Jia-qing Sun1Yue Lu2Qi-lin Yang3Peng-lai Zhao4Chun-Hua Hang5Wei Li6Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese MedicineDepartment of Neurosurgery, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing UniversityDepartment of Neurosurgery, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing UniversityDepartment of Critical Care, The Second Affiliated Hospital of Guangzhou Medical UniversityDepartment of Neurosurgery, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing UniversityDepartment of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese MedicineDepartment of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese MedicineAbstract Acute brain injury (ABI) is a leading cause of ICU admission and mortality. Effective sedation is essential for preventing secondary brain injury, and dexmedetomidine has emerged as a potential neuroprotective agent. We conducted a retrospective analysis using the MIMIC-IV v3.1 database, including adult patients admitted to the ICU with ABI. Patients were divided into two groups based on whether they received dexmedetomidine. Propensity score matching (PSM), weighting methods, and doubly robust estimation were used to adjust for confounding factors. Results from the doubly robust analysis showed that dexmedetomidine use was significantly associated with reduced in-hospital mortality (HR: 0.41, 95% CI: 0.35–0.48, p < 0.001) and ICU mortality (HR: 0.34, 95% CI: 0.28–0.41, p < 0.001). Additionally, dexmedetomidine was associated with significantly increased vasopressor-free days (MD: 2.64, 95% CI: 1.98–3.30, p < 0.001) and ventilation-free days (MD: 2.23, 95% CI: 1.59–2.86, p < 0.001). Further mediation analysis indicated that delirium mediated 37% of the effect of dexmedetomidine on in-hospital mortality and 60% of its effect on ICU mortality. This suggests that delirium may be a key mediator of dexmedetomidine’s beneficial effects, consistent with its potential advantages in sedation and neuroprotection observed in previous studies. In conclusion, dexmedetomidine use in ICU patients with ABI is associated with significantly lower mortality and improved clinical outcomes, with delirium acting as a critical mediator.https://doi.org/10.1038/s41598-025-14180-zDexmedetomidineAcute brain injuryDeliriumICUMortality. |
| spellingShingle | Juan Wang Jia-qing Sun Yue Lu Qi-lin Yang Peng-lai Zhao Chun-Hua Hang Wei Li Delirium as a mediating factor in the survival benefits of dexmedetomidine in acute brain injury management Scientific Reports Dexmedetomidine Acute brain injury Delirium ICU Mortality. |
| title | Delirium as a mediating factor in the survival benefits of dexmedetomidine in acute brain injury management |
| title_full | Delirium as a mediating factor in the survival benefits of dexmedetomidine in acute brain injury management |
| title_fullStr | Delirium as a mediating factor in the survival benefits of dexmedetomidine in acute brain injury management |
| title_full_unstemmed | Delirium as a mediating factor in the survival benefits of dexmedetomidine in acute brain injury management |
| title_short | Delirium as a mediating factor in the survival benefits of dexmedetomidine in acute brain injury management |
| title_sort | delirium as a mediating factor in the survival benefits of dexmedetomidine in acute brain injury management |
| topic | Dexmedetomidine Acute brain injury Delirium ICU Mortality. |
| url | https://doi.org/10.1038/s41598-025-14180-z |
| work_keys_str_mv | AT juanwang deliriumasamediatingfactorinthesurvivalbenefitsofdexmedetomidineinacutebraininjurymanagement AT jiaqingsun deliriumasamediatingfactorinthesurvivalbenefitsofdexmedetomidineinacutebraininjurymanagement AT yuelu deliriumasamediatingfactorinthesurvivalbenefitsofdexmedetomidineinacutebraininjurymanagement AT qilinyang deliriumasamediatingfactorinthesurvivalbenefitsofdexmedetomidineinacutebraininjurymanagement AT penglaizhao deliriumasamediatingfactorinthesurvivalbenefitsofdexmedetomidineinacutebraininjurymanagement AT chunhuahang deliriumasamediatingfactorinthesurvivalbenefitsofdexmedetomidineinacutebraininjurymanagement AT weili deliriumasamediatingfactorinthesurvivalbenefitsofdexmedetomidineinacutebraininjurymanagement |