ArticleFrontiers in pharmacology2026
Tramadol use is associated with reduced 28-day mortality in ICU patients after cardiac surgery: a retrospective study based on the MIMIC-IV database.
Article in Frontiers in pharmacology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: To evaluate the association between tramadol use and short-term outcomes, including 28-day mortality, intensive care unit (ICU) mortality, and ICU length of stay, in critically ill patients undergoing cardiac surgery. Methods: This retrospective cohort study included 3,544 participants from the MIMIC-IV database. A comprehensive analytical approach was employed, including multivariate Cox regression, subgroup analysis, propensity score matching (PSM), inverse probability weighting (IPW), doubly robust estimation, and E-value calculation. Receiver operating characteristic (ROC) curves and the DeLong test were used to compare the predictive performance of different opioids, and SHAP analysis was employed for model interpretation. Results: Tramadol use was consistently associated with a significant reduction in 28-day mortality across all models. The hazard ratios (HR) ranged from 0.305 to 0.341 after rigorous adjustment and matching (all Conclusion: Tramadol administration is independently associated with a significantly lower risk of 28-day mortality in cardiac surgery patients, showing better predictive utility than other common opioids, which may inform postoperative analgesic strategies.
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