Promising Effects of Montelukast for Critically Ill Asthma Patients via a Reduction in Delirium
<b>Background:</b> Montelukast (MTK), a potent antagonist of cysteinyl leukotriene receptor 1, has shown therapeutic promise for the treatment of neuropsychiatric disorders. Delirium, a common complication in critically ill patients, lacks effective treatment. This study aims to explore...
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MDPI AG
2024-01-01
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| Series: | Pharmaceuticals |
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| Online Access: | https://www.mdpi.com/1424-8247/17/1/125 |
| _version_ | 1827371324271493120 |
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| author | Yuan Li Meilin Zhang Shengnan Zhang Guoping Yang |
| author_facet | Yuan Li Meilin Zhang Shengnan Zhang Guoping Yang |
| author_sort | Yuan Li |
| collection | DOAJ |
| description | <b>Background:</b> Montelukast (MTK), a potent antagonist of cysteinyl leukotriene receptor 1, has shown therapeutic promise for the treatment of neuropsychiatric disorders. Delirium, a common complication in critically ill patients, lacks effective treatment. This study aims to explore the impact of pre-intensive care unit (ICU) MTK use on in-hospital delirium incidence and, subsequent, prognosis in critically ill patients. <b>Methods:</b> A retrospective cohort study (n = 6344) was conducted using the MIMIC-IV database. After propensity score matching, logistic/Cox regression, E-value sensitivity analysis, and causal mediation analysis were performed to assess associations between pre-ICU MTK exposure and delirium and prognosis in critically ill patients. <b>Results:</b> Pre-ICU MTK use was significantly associated with reduced in-hospital delirium (OR: 0.705; 95% CI 0.497–0.999; <i>p</i> = 0.049) and 90-day mortality (OR: 0.554; 95% CI 0.366–0.840; <i>p</i> = 0.005). The association was more significant in patients without myocardial infarction (OR: 0.856; 95% CI 0.383–0.896; <i>p</i> = 0.014) and could be increased by extending the duration of use. Causal mediation analysis showed that the reduction in delirium partially mediated the association between MTK and 90-day mortality (ACME: −0.053; 95% CI −0.0142 to 0.0002; <i>p</i> = 0.020). <b>Conclusions:</b> In critically ill patients, MTK has shown promising therapeutic benefits by reducing the incidence of delirium and 90-day mortality. This study highlights the potential of MTK, beyond its traditional use in respiratory disease, and may contribute to the development of novel therapeutic strategies for delirium. |
| first_indexed | 2024-03-08T10:38:37Z |
| format | Article |
| id | doaj.art-a27eb08a754d44f0b07a1ab83eb7e4f0 |
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| issn | 1424-8247 |
| language | English |
| last_indexed | 2024-03-08T10:38:37Z |
| publishDate | 2024-01-01 |
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| record_format | Article |
| series | Pharmaceuticals |
| spelling | doaj.art-a27eb08a754d44f0b07a1ab83eb7e4f02024-01-26T18:06:08ZengMDPI AGPharmaceuticals1424-82472024-01-0117112510.3390/ph17010125Promising Effects of Montelukast for Critically Ill Asthma Patients via a Reduction in DeliriumYuan Li0Meilin Zhang1Shengnan Zhang2Guoping Yang3Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha 410013, ChinaCenter of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha 410013, ChinaCenter of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha 410013, ChinaCenter of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha 410013, China<b>Background:</b> Montelukast (MTK), a potent antagonist of cysteinyl leukotriene receptor 1, has shown therapeutic promise for the treatment of neuropsychiatric disorders. Delirium, a common complication in critically ill patients, lacks effective treatment. This study aims to explore the impact of pre-intensive care unit (ICU) MTK use on in-hospital delirium incidence and, subsequent, prognosis in critically ill patients. <b>Methods:</b> A retrospective cohort study (n = 6344) was conducted using the MIMIC-IV database. After propensity score matching, logistic/Cox regression, E-value sensitivity analysis, and causal mediation analysis were performed to assess associations between pre-ICU MTK exposure and delirium and prognosis in critically ill patients. <b>Results:</b> Pre-ICU MTK use was significantly associated with reduced in-hospital delirium (OR: 0.705; 95% CI 0.497–0.999; <i>p</i> = 0.049) and 90-day mortality (OR: 0.554; 95% CI 0.366–0.840; <i>p</i> = 0.005). The association was more significant in patients without myocardial infarction (OR: 0.856; 95% CI 0.383–0.896; <i>p</i> = 0.014) and could be increased by extending the duration of use. Causal mediation analysis showed that the reduction in delirium partially mediated the association between MTK and 90-day mortality (ACME: −0.053; 95% CI −0.0142 to 0.0002; <i>p</i> = 0.020). <b>Conclusions:</b> In critically ill patients, MTK has shown promising therapeutic benefits by reducing the incidence of delirium and 90-day mortality. This study highlights the potential of MTK, beyond its traditional use in respiratory disease, and may contribute to the development of novel therapeutic strategies for delirium.https://www.mdpi.com/1424-8247/17/1/125montelukastdeliriumleukotrienecritical illness |
| spellingShingle | Yuan Li Meilin Zhang Shengnan Zhang Guoping Yang Promising Effects of Montelukast for Critically Ill Asthma Patients via a Reduction in Delirium Pharmaceuticals montelukast delirium leukotriene critical illness |
| title | Promising Effects of Montelukast for Critically Ill Asthma Patients via a Reduction in Delirium |
| title_full | Promising Effects of Montelukast for Critically Ill Asthma Patients via a Reduction in Delirium |
| title_fullStr | Promising Effects of Montelukast for Critically Ill Asthma Patients via a Reduction in Delirium |
| title_full_unstemmed | Promising Effects of Montelukast for Critically Ill Asthma Patients via a Reduction in Delirium |
| title_short | Promising Effects of Montelukast for Critically Ill Asthma Patients via a Reduction in Delirium |
| title_sort | promising effects of montelukast for critically ill asthma patients via a reduction in delirium |
| topic | montelukast delirium leukotriene critical illness |
| url | https://www.mdpi.com/1424-8247/17/1/125 |
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