Prior benzodiazepine use and mortality among adult patients with sepsis: A retrospective population-based cohort study in South Korea.

Abstract

This study investigated whether long-term benzodiazepine use is associated with increased 90-day mortality among patients with sepsis. A retrospective population-based cohort study based on health records obtained from the National Health Insurance Service database in South Korea was conducted. All adult patients (≥18years) admitted to the hospital with a primary diagnosis of sepsis or septic shock during 2010-2018 were included in the study. Sepsis and septic shock were diagnosed based on the International Classification of Diseases (10th revision: A40, A41 and R65.2). Benzodiazepine users were defined as individuals who were prescribed regular benzodiazepine continuously for over 6months before admission. A total of 251837 patients with sepsis were included in this study, 16686 of which (6.6%) were benzodiazepine users, and 235151 (93.4%) were non-users. After propensity score (PS) matching, 33370 patients (16685 in both groups) were ultimately included. Moreover, following PS matching, the 90-day mortality among benzodiazepine users and non-users was 60.9% (10167) and 41.4% (6916), respectively. Cox regression analysis further revealed the hazard ratio (HR) for 90-day mortality in benzodiazepine users to be 1.75, compared with non-users [95% confidence interval (CI): 1.70-1.81; P<.001]. Sensitivity analyses showed that, compared with non-users, HRs for 90-day mortality in benzodiazepine users without and with other psychiatric illnesses were 1.43 (95% CI: 1.38-1.49; P<.001) and 1.89 (95% CI: 1.84-1.94; P<.001), respectively. Long-term benzodiazepine use is associated with increased 90-day mortality among adult patients with sepsis compared with non-users. This association was more evident in benzodiazepine users with other psychiatric diseases, such as depression or anxiety disorder.