(984) Incidence of Dexmedetomidine-Induced Cardiovascular Adverse Drug Events in Patients With Cirrhosis

Introduction: Dexmedetomidine (DEX) is a first line sedative option that is an alpha-2 receptor agonist. This contributes to cardiovascular adverse drug reactions (CV-ADRs), such as hypotension and bradycardia. Metabolism of DEX is proportional to hepatic blood flow, potentially causing accumulation in cirrhosis patients. The purpose of this study was to assess the impact of liver disease severity on the incidence of clinically significant (CS) CV-ADRs in patients with cirrhosis receiving DEX.

Methods: This was an IRB-approved, retrospective, observational, propensity-adjusted, case-control study. Patients were included if they had cirrhosis defined by ICD-9 and 10 codes and were admitted to the ICU from July 1, 2018, through June 30, 2023. Those with mechanical circulatory support and electrical pacing were excluded. Cases were defined by experiencing a CV-ADR with documentation of a MAP < 60 mmHg, HR < 55 BPM and/or SBP < 90 mmHg plus a clinical intervention 60 minutes from the CV-ADR. Clinical interventions included fluid bolus administration, vasopressor initiation, DEX tapered faster than protocol, switching sedatives, vasopressor dose increase, or discontinuation of AV nodal blocking drugs. An inverse probability of treatment weighing was completed using the criteria of BMI, age and baseline hemodynamics. The primary outcome was the odds of developing a CS CV-ADR based on liver disease severity according to the ALBI (albumin-bilirubin) grade. The secondary outcome was identification of independent risk factors associated with CS CV-ADRs. The primary outcome was compared using a chi squared test and the secondary outcome was analyzed with a multivariable regression.

Results: 190 patients were included. The median SOFA score was 8 in each group, and 54 (28%) patients required vasopressors. Among cases, the median time to CS CV-ADR was 2.4 hours. Patients with severe liver disease (ALBI grade 3) had a significantly higher rate of CS CV-ADR when compared to those with less severe liver disease (ALBI Grade 1 and 2) at 70.5% vs. 50.5%, p = 0.005) ALBI grade 3 was independently associated with development of a CS CV-ADR (Adjusted OR 2.19; 95% CI [1.44-3.33]).

Conclusions: Patients with more severe liver disease according to ALBI grade had an increased risk of experiencing a CS CV-ADR when sedated with DEX.