Effects of esketamine on inflammatory indexes in sepsis patients in the intensive care unit

Gao Xinyue; Zeng Zhenhua; Dong Rui; Li Fen; Huang Rongjuan; Yang Hong

doi:10.3969/j.issn.1672-8521.2025.04.002

Abstract：Objective:To investigate the effect of esketamine(ESK)on inflammatory markers in patients with sepsis.Methods:A retrospective analysis was conducted on clinical data of 96 sepsis patients who received analgesia and sedation treatments in the Intensive Care Unit of the Third Affiliated Hospital of Southern Medical University from June 1,2021 to April 30,2023.Based on whether esketamine was administered,patients were divided into an ESK group(n=48)and a Non-ESK group(n=48).The ESK group received continuous infusion of esketamine combined with other sedative and analgesic drugs for 48 hours,while the Non-ESK group received other sedative and analgesic drugs without esketamine.Clinical data include collected included gender,age,underlying disease,infection sites,Sequential Organ Failure Assessment(SOFA)score,Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score,etc.The following indicators were collected before sedative and analgesic drugs infusion(0 h)and at 24 h,48 h,and 72 h after infusion:(1)Inflammatory indicators,including interleukin-6(IL-6),procalcitonin(PCT),C-reactive protein(CRP)and white blood cell(WBC)count;(2)Sedation and analgesia scores,including the Non-verbal Adult Pain Assessment scale(NVPS)score and the Richmond Agitation-sedation Scale(RASS)score;(3)Details of drug therapy,prognostic indicators and adverse reactions.Results:No significant differences were observed between the two groups in the usage rates or dosages of sedatives,analgesics,antibiotics,vasoactive drugs,or hormones within 48 hours of sedation and analgesia treatment(P＞0.05).At baseline(0 h),median levels of IL-6,PCT,CRP and WBC were 146.00 pg/mL,2.33 ng/mL,134.17 mg/L,and 12.63×109/L in the ESK group,and 271.35 pg/mL,6.14 ng/mL,160.10 mg/L,and 13.31×109/L in the Non-ESK group.In both groups,all inflammatory markers showed a decreasing trend over time at 24 h,48 h,and 72 h after treatment.In the ESK group(IL-6:96.40 pg/mL,67.01 pg/mL,42.83 pg/mL;PCT:3.79 ng/mL,2.16 ng/mL,1.78 ng/mL;CRP:113.92 mg/L,95.91 mg/L,97.82 mg/L;WBC count:13.08×109/L,11.74×109/L,9.72×109/L).In the Non-ESK group(IL-6:113.65 pg/mL,125.00 pg/mL,107.20 pg/mL;PCT:5.51 ng/mL,3.72 ng/mL,3.64 ng/mL;CRP:155.60 mg/L,135.79 mg/L,107.55 mg/L;WBC:12.78×109/L,12.68×109/L,12.29×109/L).Wald χ² values were 20.905,16.465,28.317,and 16.291 respectively(P＜0.01).The improvement of PCT and CRP in the ESK group was better than that in the Non-ESK group(Wald χ² values were 16.956 and 10.262,P＜0.01),and the improvement of WBC in the Non-ESK group was better than that in the ESK group(Wald χ² value was 13.275,P＜0.001).The 28-day successful extubation rate in the ESK group was higher than the Non-ESK group[61.9%(26/42)vs.25.8%(8/31),χ²=9.340,P＜0.01].Conclusions:The decreased level of IL-6,PCT,CRP and WBC in patients with sepsis and the increased success rate of extubation at 28 days are associated with the use of esketamine.