ORIGINAL RESEARCH article
Front. Pharmacol.
Sec. Inflammation Pharmacology
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1644635
Association of dexmedetomidine with short-term outcome in patients with cardiogenic shock: a retrospective propensity score-matched cohort study from MIMIC-IV
Provisionally accepted
- First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Background: Dexmedetomidine has been demonstrated to have cardioprotective effects in previous studies, prompting our investigation into its potential to improve survival outcomes in patients with cardiogenic shock (CS). Methods: This retrospective cohort study analyzed data from the Medical Information Mart for Intensive Care (MIMIC) IV database, focusing on patients with CS. Exposure was defined as intravenous dexmedetomidine administration during intensive care unit (ICU) stay. The primary endpoints included 7-day and 30-day all-cause mortality. External validation was conducted using the eICU 2.0 database. Results: The pre-matched and propensity score-matched (PSM) cohorts comprised 2341 and 1038 patients, respectively. Multivariable Cox regression analysis of the overall cohort revealed that dexmedetomidine administration was significantly associated with reduced risk of both 7-day (hazard ratio (HR)=0.473, 95% confidence interval (CI): 0.359-0.624, p<0.001) and 30-day all-cause mortality (HR=0.606, 95% CI: 0.500-0.735, p<0.001). This protective association persisted after PSM for 7-day (HR=0.418, 95% CI: 0.317-0.552, p<0.001) and 30-day mortality (HR=0.579, 95% CI: 0.475-0.705, p<0.001). Subgroup analyses demonstrated that patients older than 75 years, those with chronic pulmonary disease, or those with lower systolic blood pressure may not benefit from dexmedetomidine. External validation using 1411 CS patients from the eICU 2.0 database confirmed these findings, with PSM-adjusted analyses showing reduced in-hospital (HR=0.597; 95% CI: 0.395-0.901; p=0.014) and in-ICU mortality (HR=0.425; 95% CI: 0.262-0.689; p<0.001) among dexmedetomidine treated patients. Conclusion: Dexmedetomidine administration was associated with reduced risk of 7-day and 30-day all-cause mortality in CS patients, though this protective effect may not be significant in patients over 75 years, those with chronic pulmonary disease, or those with lower systolic blood pressure. Prospective studies are required to validate these findings.
Keywords: Cardiogenic shock, Dexmedetomidine, prognosis, Mortality, MIMIC-IV
Received: 12 Jun 2025; Accepted: 04 Sep 2025.
Copyright: © 2025 Xie, Chen, Sasmita, Li, Luo and Huang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Bi Huang, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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