Dexmedetomidine improved renal function in patients with severe sepsis: an exploratory analysis of a randomized controlled trial
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Open Access
- 2 January 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Journal of Intensive Care
- Vol. 8 (1), 1-9
- https://doi.org/10.1186/s40560-019-0415-z
Abstract
Dexmedetomidine has been reported to improve organ dysfunction in critically ill patients. In a recent randomized controlled trial (Dexmedetomidine for Sepsis in Intensive Care Unit (ICU) Randomized Evolution [DESIRE]), we demonstrated that dexmedetomidine was associated with reduced mortality risk among patients with severe sepsis. We performed this exploratory sub-analysis to examine the mechanism underlying improved survival in patients sedated with dexmedetomidine. The DESIRE trial compared a sedation strategy with and without dexmedetomidine among 201 mechanically ventilated adult patients with sepsis across eight ICUs in Japan. In the present study, we included 104 patients with Acute Physiology and Chronic Health Evaluation II (APACHE II) scores of ≥ 23 (54 in the dexmedetomidine [DEX] group and 50 in the non-dexmedetomidine [non-DEX] group). Initially, we compared the changes in the sequential organ failure assessment (SOFA) scores from the baseline within 6 days after randomization between groups. Subsequently, we evaluated the variables comprising the organ component of the SOFA score that showed relevant improvement in the initial comparison. The mean patient age was 71.0 ± 14.1 years. There was no difference in the median APACHE II score between the two groups (29 [interquartile range (IQR), 25–31] vs. 30 [IQR, 25–33]; p = 0.35). The median SOFA score at the baseline was lower in the DEX group (9 [IQR, 7–11] vs. 11 [IQR, 9–13]; p = 0.01). While the renal SOFA subscore at the baseline was similar for both groups, it significantly decreased in the DEX group on day 4 (p = 0.02). During the first 6 days, the urinary output was not significantly different (p = 0.09), but serum creatinine levels were significantly lower (p = 0.04) in the DEX group. The 28-day and in-hospital mortality rates were significantly lower in the DEX group (22% vs. 42%; p = 0.03, 28% vs. 52%; p = 0.01, respectively). A sedation strategy with dexmedetomidine is associated with improved renal function and decrease mortality rates among patients with severe sepsis. This trial was registered on ClinicalTrials.gov (NCT01760967) on January 1, 2013.Keywords
Funding Information
- Hospira Japan (none)
This publication has 23 references indexed in Scilit:
- Dexmedetomidine as a promising prevention strategy for cardiac surgery-associated acute kidney injury: a meta-analysisCritical Care, 2017
- The effect of dexmedetomidine on renal function in patients undergoing cardiac valve replacement under cardiopulmonary bypass: A double-blind randomized controlled trialJournal of Clinical Anesthesia, 2017
- Effect of Dexmedetomidine on Mortality and Ventilator-Free Days in Patients Requiring Mechanical Ventilation With SepsisJAMA, 2017
- Dexmedetomidine Attenuates the Microcirculatory Derangements Evoked by Experimental SepsisAnesthesiology, 2015
- Sepsis-induced acute kidney injury revisitedCurrent Opinion in Critical Care, 2014
- α2-Adrenoceptor agonist dexmedetomidine protects septic acute kidney injury through increasing BMP-7 and inhibiting HDAC2 and HDAC5American Journal of Physiology-Renal Physiology, 2012
- Dexmedetomidine vs Midazolam or Propofol for Sedation During Prolonged Mechanical VentilationJAMA, 2012
- Dose- and time-related effects of dexmedetomidine on mortality and inflammatory responses to endotoxin-induced shock in ratsJournal of Anesthesia, 2008
- Effects of dexmedetomidine on mortality rate and inflammatory responses to endotoxin-induced shock in ratsCritical Care Medicine, 2004
- The Effects of Increasing Plasma Concentrations of Dexmedetomidine in HumansAnesthesiology, 2000