PDF(Pubmed)
Abstract：
Background: Montelukast (MTK), a potent antagonist of cysteinyl leukotriene receptor 1, has shown therapeutic promise for the treatment of neuropsychiatric disorders. Delirium, a common complication in critically ill patients, lacks effective treatment. This study aims to explore the impact of pre-intensive care unit (ICU) MTK use on in-hospital delirium incidence and, subsequent, prognosis in critically ill patients. Methods: A retrospective cohort study (n = 6344) was conducted using the MIMIC-IV database. After propensity score matching, logistic/Cox regression, E-value sensitivity analysis, and causal mediation analysis were performed to assess associations between pre-ICU MTK exposure and delirium and prognosis in critically ill patients. Results: Pre-ICU MTK use was significantly associated with reduced in-hospital delirium (OR: 0.705; 95% CI 0.497-0.999; p = 0.049) and 90-day mortality (OR: 0.554; 95% CI 0.366-0.840; p = 0.005). The association was more significant in patients without myocardial infarction (OR: 0.856; 95% CI 0.383-0.896; p = 0.014) and could be increased by extending the duration of use. Causal mediation analysis showed that the reduction in delirium partially mediated the association between MTK and 90-day mortality (ACME: -0.053; 95% CI -0.0142 to 0.0002; p = 0.020). Conclusions: In critically ill patients, MTK has shown promising therapeutic benefits by reducing the incidence of delirium and 90-day mortality. This study highlights the potential of MTK, beyond its traditional use in respiratory disease, and may contribute to the development of novel therapeutic strategies for delirium.
摘要：
背景：孟鲁司特（MTK），半胱氨酰白三烯受体1的有效拮抗剂，已显示出治疗神经精神疾病的治疗前景。谵妄,危重病人常见的并发症，缺乏有效的治疗。本研究旨在探讨重症监护病房(ICU)前使用MTK对院内谵妄发生率的影响,随后,危重患者的预后。方法：使用MIMIC-IV数据库进行回顾性队列研究（n=6344）。在倾向得分匹配后，逻辑/Cox回归，E值敏感性分析，我们进行了因果中介分析,以评估ICU前MTK暴露与危重患者谵妄和预后之间的关联.结果：ICU前使用MTK与降低院内谵妄（OR：0.705；95%CI0.497-0.999；p=0.049）和90天死亡率（OR：0.554；95%CI0.366-0.840；p=0.005）显著相关。在没有心肌梗死的患者中，该相关性更为显着（OR：0.856；95％CI0.383-0.896；p=0.014），并且可以通过延长使用时间来增加。因果中介分析显示，谵妄的减少部分介导了MTK与90天死亡率之间的关联（ACME：-0.053；95％CI-0.0142至0.0002；p=0.020）。结论：在危重患者中，MTK通过降低谵妄发生率和90天死亡率显示出有希望的治疗益处。这项研究强调了MTK的潜力，除了它在呼吸系统疾病中的传统用途之外，并可能有助于开发谵妄的新治疗策略。
