EXPRESS: Association between acetaminophen and risk of mortality in patients with sepsis-associated acute kidney injury: A retrospective cohort study from the MIMIC-IV database

The occurrence of sepsis-associated acute kidney injury (SA-AKI) predicts a worse prognosis. We aimed to assess the impact of acetaminophen use on short-term mortality in patients with SA-AKI. A total of 6,563 patients diagnosed with SA-AKI from the 2008-2019 Medical Information Mart for Intensive Care IV (MIMIC-IV) database were enrolled in this retrospective cohort study. The Cox regression model was utilized to analyze the associations of acetaminophen with 30-day mortality and in-hospital mortality. Additional propensity score matching (PSM) analysis was performed regarding patients with acetaminophen use versus those without. Of these patients, 30-day mortality occurred in 1,421 (21.65%) patients and in-hospital mortality in 1,246 (18.99%) patients. Patients who used acetaminophen were associated with a reduced risk of 30-day mortality [hazard ratio (HR)=0.80, 95% confidence interval (CI): 0.71-0.90] and in-hospital mortality (HR=0.72, 95%CI: 0.63-0.82). The PSM analysis demonstrated that acetaminophen use was still related to a reduced risk of 30-day mortality and in-hospital mortality. Subgroup analysis showed that the relationships between acetaminophen and 30-day mortality and in-hospital mortality were consistent across subgroups (P<0.05). The use of acetaminophen has an association with lower short-term mortality in patients with SA-AKI.