The association between ondansetron use and mortality risk of traumatic brain injury patients: a population-based study

Ruoran Wang; Jing Zhang; Jianguo Xu; Min He

doi:10.3389/fphar.2024.1362309

The association between ondansetron use and mortality risk of traumatic brain injury patients: a population-based study

Front Pharmacol. 2024 May 2:15:1362309. doi: 10.3389/fphar.2024.1362309. eCollection 2024.

Authors

Ruoran Wang^#¹, Jing Zhang^#¹, Jianguo Xu¹, Min He²

Affiliations

¹ Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
² Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.

^# Contributed equally.

Abstract

Background: Traumatic brain injury (TBI) patients suffer high risks of mortality. Ondansetron has been verified to be effective in improving the prognosis of some kinds of critically ill patients. We design this study to explore whether ondansetron use is associated with lower risks of mortality among TBI patients.

Methods: TBI patients from the Medical Information Mart for Intensive Care-III were collected. The usage of ondansetron, including intravenous injection and oral tablet, since admission to the Beth Israel Deaconess Medical Center between 2001 and 2012 was identified. Univariate and multivariate logistic regression were performed to analyze the relationship between the ondansetron use and mortality of TBI patients. Propensity score matching (PSM) was utilized to generate balanced cohorts of the non-ondansetron use group and ondansetron use group. Sub-group analysis was performed to verify the association between the ondansetron use and mortality of TBI patients in different TBI severity levels after PSM.

Results: In TBI cohorts before PSM, the usage incidence of ondansetron was 37.2%. The 30-day mortality was significantly lower in the ondansetron group (p < 0.001). The multivariate logistic regression showed that ondansetron was associated with the lower mortality of TBI patients (p = 0.008). In TBI cohorts after PSM, the 30-day mortality of the ondansetron group was lower than that of the non-ondansetron group, although without statistical significance (p = 0.079). Logistic regression indicated ondansetron use was significantly associated with the lower mortality of moderate-to-severe TBI (p < 0.001) but not mild TBI (p = 0.051). In addition, Cox regression also presented that ondansetron use was significantly associated with the lower mortality of moderate-to-severe TBI (p < 0.001) but not mild TBI (p = 0.052).

Conclusion: Ondansetron usage is associated with a lower mortality risk of moderate-to-severe TBI but not mild TBI patients. Ondansetron may be a novel adjunctive therapeutic strategy to improve the prognosis of moderate-to-severe TBI patients.

Keywords: 5-HT3 receptor antagonist; mortality; ondansetron; population study; traumatic brain injury.

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This study was funded by the 1·3·5 project for disciplines of excellence—Clinical Research Incubation Project, West China Hospital, Sichuan University (2020HXFH036), the Knowledge Innovation Program of the Chinese Academy of Sciences (JH2022007), the National Natural Science Foundation of China (82173175), and the Department of Science and Technology of Sichuan Province (24QYCX0411).