Dexmedetomidine on the Prognosis of Patients With Sepsis-related Acute Kidney Injury

Introduction. To investigate the effect of dexmedetomidine (DEX) on the prognosis and renal function recovery in patients with sepsis-associated AKI (SA-AKI). Methods. A prospective observational study was conducted, enrolling patients with SA-AKI admitted to the ICU of Suzhou Municipal Hospital from July ۲۰۲۱ to June ۲۰۲۳. Patients were divided into a DEX group and a non-DEX group according to the sedation regimen. Results. After matching, a total of ۲۰۴ patients (۱۰۲ in each group) were included, with balanced baseline (SMD < ۱۰%). The primary endpoint: DEX significantly reduced the risk of ۲۸-day mortality (adjusted HR = ۰.۵۵۶, ۹۵% CI:۰.۳۱۷ to ۰.۹۷۵; P = .۰۴۱), with a particularly significant benefit in patients with nonseptic shock (HR = ۰.۳۷۲, P = .۰۱۶) and AKI stage ۱ (HR = ۰.۳۷۵, P = .۰۳۵). Secondary endpoints: DEX significantly improved the rate of renal function recovery (adjusted OR = ۲.۸۴۱, ۹۵% CI:۱.۴۲۷ to ۵.۶۵۶; P = .۰۰۳), and the efficacy was modified by AKI stage (P-interaction = .۰۰۵) and shock status (P-interaction = .۰۰۶). The benefit was most prominent in patients with AKI stage ۱ (P = .۰۰۹) ; the benefit was clear in patients with non-septic shock (P = .۰۱۱). There was a strong trend toward benefit in patients with septic shock (P = .۰۵۴). There was no difference in ICU length of stay between the two groups (P > .۰۵). Conclusions. DEX significantly improves survival and promotes renal function recovery in patients with SA-AKI, particularly in patients with stage ۱ AKI and non-septic shock. The potentially significant benefit observed in patients with septic shock warrants further validation in a larger sample.Introduction. To investigate the effect of dexmedetomidine (DEX) on the prognosis and renal function recovery in patients with sepsis-associated AKI (SA-AKI). Methods. A prospective observational study was conducted, enrolling patients with SA-AKI admitted to the ICU of Suzhou Municipal Hospital from July ۲۰۲۱ to June ۲۰۲۳. Patients were divided into a DEX group and a non-DEX group according to the sedation regimen. Results. After matching, a total of ۲۰۴ patients (۱۰۲ in each group) were included, with balanced baseline (SMD < ۱۰%). The primary endpoint: DEX significantly reduced the risk of ۲۸-day mortality (adjusted HR = ۰.۵۵۶, ۹۵% CI:۰.۳۱۷ to ۰.۹۷۵; P = .۰۴۱), with a particularly significant benefit in patients with nonseptic shock (HR = ۰.۳۷۲, P = .۰۱۶) and AKI stage ۱ (HR = ۰.۳۷۵, P = .۰۳۵). Secondary endpoints: DEX significantly improved the rate of renal function recovery (adjusted OR = ۲.۸۴۱, ۹۵% CI:۱.۴۲۷ to ۵.۶۵۶; P = .۰۰۳), and the efficacy was modified by AKI stage (P-interaction = .۰۰۵) and shock status (P-interaction = .۰۰۶). The benefit was most prominent in patients with AKI stage ۱ (P = .۰۰۹) ; the benefit was clear in patients with non-septic shock (P = .۰۱۱). There was a strong trend toward benefit in patients with septic shock (P = .۰۵۴). There was no difference in ICU length of stay between the two groups (P > .۰۵). Conclusions. DEX significantly improves survival and promotes renal function recovery in patients with SA-AKI, particularly in patients with stage ۱ AKI and non-septic shock. The potentially significant benefit observed in patients with septic shock warrants further validation in a larger sample.

کلیدواژه ها:

Dexmedetomidine ، sepsis ، acute kidney injury ، mortality ، intensive care