Ramelteon and Mortality in Patients With Sepsis and Cancer: Insights From a Propensity-Matched Analysis of the MIMIC-IV Database.

PURPOSE: This study aimed to evaluate the association between ramelteon use and mortality outcomes in patients with sepsis and cancer. The research question was whether ramelteon use is associated with reduced mortality in this high-risk patient population. METHODS: A retrospective analysis of the MIMIC-IV database was conducted. We included 3283 patients with sepsis and cancer, with 424 receiving ramelteon and 2859 not receiving ramelteon. Missing data (< 20%) were imputed using random forest. Propensity score matching (PSM) was used to balance baseline characteristics between groups (1:1 matching, caliper width of 0.1), resulting in 400 patients in each group. Kaplan-Meier curves were used to compare survival probabilities, and Cox regression and logistic regression analyses were performed to assess the association between ramelteon and mortality outcomes. RESULTS: Ramelteon use was significantly associated with lower 30-day (HR: 0.37, 95% CI: 0.28-0.50, p < 0.001), 90-day (HR: 0.39, 95% CI: 0.29-0.52, p < 0.001), ICU (OR: 0.29, 95% CI: 0.18-0.46, p < 0.001), and in-hospital mortality (OR: 0.50, 95% CI: 0.35-0.72, p < 0.001) in the fully adjusted model after PSM. In exploratory duration-related analyses, ramelteon use for ≤ 7 days was associated with lower mortality, whereas no additional significant association was observed with longer duration. CONCLUSION: Ramelteon use was associated with lower mortality among patients with sepsis and cancer. However, given the observational design and potential residual confounding, these findings should be interpreted as hypothesis-generating and require confirmation in prospective studies.