Impact of Dexmedetomidine on the Prognosis of Patients with Sepsis-Induced Myocardial Injury: A Retrospective Cohort Study

BackgroundSepsis-Induced Myocardial Injury (SIMI) is a serious complication with high in-hospital and 28-day mortality. Dexmedetomidine (DEX), a selective 2-adrenergic receptor agonist, has shown anti-inflammatory and cardioprotective effects, but its impact on SIMI prognosis is unclear. MethodsThis retrospective study used the MIMIC-IV database, including SIMI patients diagnosed per Sepsis-3 criteria. Propensity score matching (PSM) balanced baseline characteristics, and Cox regression analyzed the association between DEX use and mortality outcomes. External validation was performed using the MIMIC-III database. ResultsAmong 3,921 SIMI patients (375 DEX, 3,546 non-DEX), DEX use showed a trend toward lower 28-day mortality (HR 0.49, 95% CI 0.23-1.05, p = 0.068) and in-hospital mortality (HR 0.45, 95% CI 0.20-1.02, p = 0.055). After PSM, mortality remained lower in the DEX group. ICU and hospital stays were longer in the DEX group, but CRRT use showed no significant differences. External validation confirmed these findings. ConclusionDEX use may reduce 28-day and in-hospital mortality in SIMI patients, providing preliminary evidence for its potential benefits. Further large-scale studies are needed to confirm these results.