# Early acetaminophen Use and 90-day mortality in ICU patients with ischemic stroke

## TL;DR

This study suggests that early use of acetaminophen in ICU patients with ischemic stroke may reduce 90-day mortality, beyond its role in managing symptoms.

## Contribution

The study identifies a potential survival benefit of early acetaminophen use in ICU ischemic stroke patients, beyond temperature and pain control.

## Key findings

- Early acetaminophen use was associated with reduced 30-day and 90-day mortality in ICU ischemic stroke patients.
- No significant differences were observed in in-hospital mortality or hospital length of stay.
- Subgroup analyses showed consistent associations across different clinical strata.

## Abstract

The impact of acetaminophen on the prognosis of ischemic stroke patients admitted to intensive care units remains unclear. Although acetaminophen is commonly used for fever and pain management, its potential benefits beyond temperature control require further investigation.

Using the MIMIC-IV database, we retrospectively identified 494 ICU-admitted ischemic stroke patients, of whom 362 (73.28%) received early acetaminophen treatment within 48 h after ICU admission. Patients were stratified based on acetaminophen exposure. Weighted Cox regression was applied after inverse probability of treatment weighting (IPTW) adjustment. Subgroup and sensitivity analyses were performed to assess the consistency of associations.

After IPTW adjustment, early acetaminophen use was associated with reduced 30-day mortality (HR 0.54, 95% CI 0.31–0.94, p = 0.030), and reduced 90-day mortality (HR 0.53, 95% CI 0.32–0.87, p = 0.013). There were no significant differences in in-hospital mortality or hospital length of stay. Subgroup analyses revealed no significant interaction effects, suggesting a consistent association across different clinical strata.

Early acetaminophen use may be associated with improved survival outcomes in critically ill ischemic stroke patients. These findings highlight the potential therapeutic value of acetaminophen beyond symptomatic treatment, warranting confirmation through prospective, multicenter randomized controlled trials.