Objective  To investigate the association of ondansetron use with short-term mortality risk and long-term mortality risk in patients with cerebrovascular disease.

Methods  Clinical data of patients with cerebrovascular disease admitted to the intensive care unit (ICU) between 2008 and 2022 from the MIMIC-Ⅳ database were retrospectively collected. All enrolled subjects were divided into an ondansetron group and a non-ondansetron group according to whether they had used ondansetron during their hospitalization. The differences in clinical indicators between the two groups were equalized using a 1∶1 propensity score matching (PSM) method. Kaplan-Meier survival analyses were employed to compare the differences in survival rates between the two groups at ICU, hospital, 30- and 90-day, respectively. Cox proportional-hazards regression models were employed to analyze the associations between ondansetron use and ICU, hospital, and 30-and 90-day all-cause mortality in critically ill patients with cerebrovascular disease.

Results  The study included 9,198 patients with cerebrovascular disease, including 3,514 in the ondansetron group and 5,684 in the non-ondansetron group. Pre-matched baseline data showed that the overall ICU, hospital, and 30- and 90-day mortality rates in the ondansetron group were 7.0%, 12.4%, 15.9%, and 21.3% respectively, while those in the non-ondansetron group were 11.0%, 17.2%, 22.3% and 27.9% respectively. After 1∶1 PSM equalization of baseline data, a total of 3,239 pairs were successfully matched. Based on the matched data, Kaplan-Meier survival analyses showed higher survival rates of ICU (P<0.001), hospital (P<0.001), 30 d (P<0.001), and 90 d (P<0.001) in the ondansetron group compared to the non-ondansetron group. In Cox proportional-hazards analysis, after adjustment for potential confounders, the hazard ratios (HR) in the ondansetron group relative to the non-ondansetron group were 0.60 [95%CI (0.51, 0.71), P<0.001] for ICU mortality, 0.73 [95%CI (0.64, 0.83), P<0.001] for hospital mortality, 0.76 [95%CI (0.67, 0.85), P<0.001] for 30 d mortality, and 0.81 [95%CI (0.73, 0.89), P<0.001] risk ratio for 90 d mortality.

Conclusion  The use of ondansetron may significantly decrease the ICU, hospital, 30 d and 90 d risk of mortality in patients with severe cerebrovascular disease.

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