Abstract
Mannitol is widely used for treating brain edema caused by various diseases, but it has been reported to cause acute kidney injury. However, the prognosis for patients with non-traumatic intracerebral hemorrhage who also have acute kidney injury and continue to receive mannitol has not yet been documented. This study presents a retrospective cohort analysis utilizing the MIMIC-IV (medical information mart for intensive care-IV) database. The study population comprised adult patients diagnosed with non-traumatic intracerebral hemorrhage (ICH) and concurrent acute kidney injury (AKI). Mannitol administration during the intensive care unit (ICU) stay was considered the exposure variable. The primary endpoint for analysis was 28-day all-cause mortality. To account for potential confounding factors, multivariable analytical methods were employed. The 28-day mortality rate within the total cohort was 25%. In the mannitol group, the 28-day mortality rate was 50.4% (58/115), compared to 21.9% (203/927) in the control group. Mannitol use was associated with a significantly higher 28-day all-cause mortality in both the multivariable analysis (HR 2.42; 95% CI 1.80-3.25; p < 0.001) and the univariable analysis (HR 2.31; 95% CI 1.67-3.19; p < 0.001). Other variables independently associated with mortality included higher heart rate, mean arterial pressure, respiratory rate, platelet count, sodium, chloride, lactate, urea nitrogen, creatinine, SAPSII, SOFA, GCS, and Charlson Index. The in-hospital mortality rate was 47.8% (55 out of 115) in the mannitol treatment group and 16.2% (150 out of 927) in the non-treatment group. Mannitol use was associated with higher 28-day all-cause mortality in patients with non-traumatic ICH and AKI. However, given the methodological limitations and incomplete confounder adjustment of this study, this finding should be interpreted with caution. Further research is needed to confirm this relationship and explore the underlying mechanisms.