Propofol Sedation Linked to Lower One-Year Mortality in Sepsis-Associated Encephalopathy: Study

A new research published in the PloS One journal that among patients with sepsis-associated encephalopathy (SAE), propofol monotherapy was associated with lower one-year all-cause mortality compared with no sedation therapy. These findings suggest propofol sedation may offer a survival benefit in managing patients with SAE.

Sepsis-associated encephalopathy is characterized by diffuse brain dysfunction without direct central nervous system infection. Given its high incidence, mortality rate, and potential for long-term cognitive impairment, identifying modifiable treatment factors has become a priority in intensive care research. Sedation therapy, commonly administered to manage agitation and distress in ICU patients, has remained controversial due to concerns over its impact on long-term outcomes.

This study analyzed 4,618 adult ICU patients diagnosed with SAE. Of these, 3,343 patients received sedative therapy during the first 24 hours of ICU admission, while 1,275 did not. To strengthen the reliability of comparisons, investigators used propensity score matching (PSM), generating 511 well-balanced patient pairs with similar baseline characteristics.

The baseline characteristics table outlined demographic details such as age and sex distribution, along with vital signs including heart rate, blood pressure, respiratory rate, and oxygen saturation recorded within the first 24 hours. Laboratory parameters like white blood cell count, lactate levels, renal and liver function markers, were also included, reflecting the severity of systemic infection and organ dysfunction.

Comorbidities like diabetes, chronic kidney disease, and cardiovascular disease were documented, as were severity scoring systems commonly used in ICUs. Treatment variables in the table covered mechanical ventilation use, vasopressor support, antimicrobial therapy, and different sedative regimens.

The primary results table focused on hazard ratios (HRs) derived from Cox proportional hazards models assessing one-year all-cause mortality. Propofol monotherapy demonstrated a statistically significant protective association, with a hazard ratio of 0.51 (95% confidence interval 0.40–0.65; P < 0.001), which indicated nearly a 49% reduction in mortality risk compared with no sedation.

These findings remained robust after propensity score matching, supporting the consistency of the association. However, subgroup analysis revealed a noteworthy interaction between propofol use and mechanical ventilation. Among patients who required ventilation support on the first day of ICU admission, the protective effect was attenuated.

The interaction analysis showed a hazard ratio of 0.70 (95% CI 0.49–1.00), with a statistically significant interaction term (P = 0.041). This suggests that the benefits of propofol sedation may differ depending on respiratory support status. Overall, the study highlights the potential survival benefit of carefully selected sedation strategies in SAE.

Reference:

Li, Y., Huang, H., & Shuai, B. (2026). Propofol provides a significant survival advantage in sepsis-associated encephalopathy: A retrospective cohort study investigating one-year all-cause mortality. PloS One, 21(2), e0340371. https://doi.org/10.1371/journal.pone.0340371