(P-556) Survival Analysis of N-acetylcysteine Administration in ICU Patients from the MIMIC III v1.4 Database

Location: Poster Gallery-Drug Effectiveness

Presenting Author(s)

MM

Mohamed A. Mekkawy, n/a

Head of the Clinical Pharmacy, Alexandria Police Hospital
High Institute of Public Health, Alexandria University - Egypt
Alexandria, Al Iskandariyah, Egypt

Co-Author(s)

OZ

Ola A. Zaafan, n/a

Faculty of Pharmacy, Alexandria University - Egypt, Kafr ash Shaykh, Egypt

Background: MIMIC-III v1.4 is a large, freely-available database comprising de-identified health-related data associated with over forty thousand patients who stayed in critical care units of the Beth Israel Deaconess Medical Center between 2001 and 2012. The database includes information such as demographics, vital sign measurements made at the bedside, laboratory test results, procedures, medications, caregiver notes, imaging reports, and mortality.
N-acetylcysteine is an amino acid that acts as an antioxidant, both directly as a glutathione substitute and indirectly as a precursor for glutathione. It also causes vasodilation by increasing cyclic guanosine monophosphate levels, inhibits platelet aggregation, acts as a sulphydryl donor to regenerate endothelial-derived relaxing factor and reduces IL-8 and TNF-alpha production. While there is evidence for its effectiveness as an antidote to paracetamol poisoning, its use in other disorders has only experimental or anecdotal support.

Objectives: To evaluate N-acetylcysteine effect on survival in ICU patients from the MIMIC III v1.4 database

Methods: The database was queried for N-acetylcysteine prescriptions, then for another equal number of control cases with no N-acetylcysteine prescriptions selected randomly from the database. Length of stay and discharge status as either alive or dead were collected. Data were analyzed using IBM SPSS version 27 to calculate Kaplan-Meier estimates for comparing survival between the two groups.

Results: We identified 2929 records of patients prescribed N-acetylcysteine, and another 2929 records of patients not prescribed N-acetylcysteine were randomly selected to include in the analysis. 509 (17.38%) death cases occurred in the N-acetylcysteine group Vs 317 (10.82%) in the control group. The median survival for patients receiving N-acetylcysteine was 32 days, while the median survival for patients not receiving N-acetylcysteine was not reached. (log-rank test, p=0.013)

Conclusions: N-acetylcysteine administration to ICU patients showed increased mortality and shorter survival times as demonstrated by the data obtained from the MIMIC III v1.4 database.