1230: INTENSIVE CARE UNIT USE OF MELATONIN RECEPTOR AGONISTS IMPROVES OUTCOMES IN SEPSIS PATIENTS

Abstract

Introduction: Delirium aggravates the morbidity and mortality of sepsis patients. Melatonin, the endogenous circadian rhythm regulating hormone, can decrease delirium. Also, melatonin possesses anti-oxidation and anti-inflammation capacity. Of note, the effects of melatonin can be activated by melatonin receptor agonists (such as tasimelteon and ramelteon). Thus, we hypothesized that using melatonin receptor agonists may improve the outcomes of sepsis patients in intensive care unit (ICU). To elucidate further on this issue, we conducted this retrospective study analyzing data retrieved from the Medical Information Mart for Intensive Care (MIMIC) IV database. Methods: Data from the MIMIC IV database were retrieved and analyzed. Only sepsis patients admitted to ICU were included. Patients who stayed in ICU less than 3 days were excluded. Between-group differences in the in-hospital mortality and overall mortality rates were analyzed using the Chi square test. The impacts of ICU use of melatonin receptor agonists on in-hospital mortality and overall mortality in sepsis patients were analyzed using logistic regression analysis. Results: A total of 3943 sepsis patients were included. Among them, 3.78% received melatonin receptor agonists (the Melatonin group, n=149), and ramelteon was the only melatonin receptor agonist these patients received. In addition, 96.22% of the included sepsis patients did not use melatonin receptor agonists (the non-Melatonin group, n=3794) during the entire course of hospitalization. In-hospital mortality rate (20.8% versus 31.0%, p=0.008) and the overall mortality rate (27.5% versus 39.3%%, p=0.004) in the Melatonin group were significantly lower than in the non-Melatonin group. Logistic regression analysis revealed that Melatonin group were associated with significantly lower risks of in-hospital mortality (odd’s ratio [OR]: 0.59, 95% confidence intervals [CI]: 0.39~0.88, p=0.009) and overall mortality (OR: 0.59, 95% CI: 0.41~0.84, p=0.004) comparing to non-Melatonin group. After adjusting for age and gender, the trend remained the same (in-hospital mortality: OR: 0.56, 95% CI: 0.37~0.84, p=0.005; overall mortality: OR: 0.56, 95% CI: 0.38~0.80, p=0.002). Conclusions: ICU use of melatonin receptor agonist ramelteon associated with outcome improvements in sepsis patients.