Dexmedetomidine reduces the inflammation level and morality in adult sepsis: a systemic review and meta-analysis based on randomized controlled trials

Background Sepsis is a systemic inflammatory response syndrome characterized by an inflammatory cytokine storm and immune dysregulation. The clinical benefits of dexmedetomidine in patients with sepsis remain unclear. This study aimed to explore the effects of dexmedetomidine on the inflammatory status and clinical outcomes of patients with sepsis. Methods This study searched PubMed, Embase, and the Cochrane Library for records from the setup day of each database up to August 1, 2025. The search strategy was as follows: (Dexmedetomidine OR Dexmedetomidine Hydrochloride OR Precedex OR Igami) AND (Sepsis OR Bloodstream Infection OR Bloodstream Infections OR Septicemia OR Septicemias). The primary outcomes included interleukin-6 (IL-6), tumor necrosis factor- α (TNF-α), and C-reactive protein (CRP). The secondary outcome measures included in-hospital mortality, ICU mortality, 28-day mortality, length of ICU stay, ventilator-free days at day 28, Sequential Organ Failure Assessment (SOFA) score, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score. Stata 14.0 was used for data analysis. Results A total of 1,550 sepsis patients were included in this study, among whom 759 received dexmedetomidine treatment. Regarding inflammatory factors, the analysis results showed that dexmedetomidine significantly reduced interleukin-6 (IL-6) [standardized mean difference (SMD) = 0.04, 95% confidence interval (95%CI) = (−0.11, 0.19), p = 0.574] and tumor necrosis factor- α (TNF-α) levels [SMD = −2.39, 95, 95%CI = (−3.52, −1.27), p < 0.001] in sepsis patients, while exerting no effect on C-reactive protein (CRP) levels. In terms of clinical prognosis, the analysis indicated that dexmedetomidine significantly decreased hospital mortality [relative risk (RR) = 0.65, 95% confidence interval (95%CI) = (0.45, 0.94), p = 0.021] and 28-day mortality [RR = 0.68, 95%CI = (0.55, 0.84), p < 0.001] in sepsis patients, with no impact on other secondary outcome measures. Conclusion Dexmedetomidine can reduce the levels of IL-6 and TNF-αin patients with sepsis, while also decreasing in-hospital mortality and 28-day mortality. Furthermore, early identification of sepsis and subsequent administration of dexmedetomidine for sedation and anti-inflammatory therapy may yield more pronounced clinical benefits.