• Ying Liu, Jiao Peng, Yuan-Hui Zhang, and Hai-Tao Liu.
• Department of Anaesthesiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, Fujian, China.
• World Neurosurg. 2024 Dec 5.

BackgroundSubarachnoid hemorrhage (SAH) is a severe neurological event with high mortality. The choice of sedatives in SAH management may influence patient outcomes. This study aimed to investigate the association between sedatives and in-hospital mortality among SAH patients.MethodsThis study analyzed data from the MIMIC-IV database, and in-hospital mortality was the primary outcome. Key variables collected included sedatives, demographics, comorbidities, vital signs, laboratory tests, and severity scores. Univariate and multivariate logistic regression analyses were used to assess associations between sedative use and in-hospital mortality, with adjustments for confounding factors. Further stratified analyses explored the effects of dexmedetomidine across different patient subgroups, and mediation analysis evaluated creatinine's role in the relationship between dexmedetomidine and mortality.ResultsA total of 527 patients were included in this study, with 301 males. Compared to propofol and midazolam, the use of dexmedetomidine was significantly related to the reduction of in-hospital mortality in SAH patients (OR = 0.369, 95% CI: 0.237-0.574, p < 0.001). After adjusting for variables such as demographics, comorbidities, and laboratory tests, dexmedetomidine remained associated with lower in-hospital mortality. Additionally, our findings indicated that dexmedetomidine use was associated with a reduced risk of in-hospital mortality regardless of the presence of cerebrovascular disease. Importantly, we discovered that creatinine acted as a mediator in the protective effect of dexmedetomidine on in-hospital mortality.ConclusionDexmedetomidine is associated with significantly lower in-hospital mortality in SAH patients. These findings underscore the importance of sedative choice for SAH patients, suggesting that dexmedetomidine could enhance patient outcomes.Copyright © 2024. Published by Elsevier Inc.

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