Association of early acetaminophen administration with mortality among critically ill patients with ischemic stroke: a retrospective cohort study

The therapeutic effect of early acetaminophen administration in patients diagnosed with ischemic stroke remains inconclusive. In particular, its impact on clinical outcomes among critically ill patients admitted to the intensive care unit (ICU) has not been fully characterized. This study aimed to evaluate the association between early acetaminophen exposure and clinical outcomes in patients in the ICU with ischemic stroke through a retrospective analysis of the Medical Information Mart for Intensive Care IV (MIMIC-IV) version 2.2 database. A total of 1,419 ICU patients with a diagnosis of ischemic stroke were included in this retrospective database study. To address baseline differences between treatment groups, propensity score matching (PSM) was performed. The primary outcome was 90-day all-cause mortality. Secondary outcomes included 30-day mortality, ICU length of stay, and in-hospital mortality. Analyses were conducted in the matched cohort to assess the associations between early acetaminophen administration, defined as administration within 48 h of ICU admission, and these outcomes. Of the study population, 839 patients received acetaminophen within 48 h of ICU admission, and 580 did not. Following PSM, 505 matched pairs were obtained. Kaplan–Meier survival analysis demonstrated significantly improved survival in the early acetaminophen group compared to the untreated group (p < 0.05). Multivariable Cox proportional hazards regression analysis, adjusted for relevant covariates, demonstrated that early acetaminophen exposure was associated with a lower 90-day mortality rate (27.72% vs. 37.03%; hazard ratio [HR] = 0.73; 95% confidence interval [CI] = 0.59 to 0.91; p < 0.05). Early acetaminophen administration within 48 h of ICU admission was associated with lower mortality among patients with ischemic stroke. Additional improvements were observed in 30-day mortality, in-hospital mortality, and ICU length of stay.