Early Sucralfate Administration Improves Prognosis in Sepsis: A Propensity Score Matched Cohort Study

Background Sepsis remains a major healthcare challenge, with high morbidity and mortality despite advances in treatment. Emerging evidence highlights the role of intestinal barrier dysfunction in sepsis, yet therapeutic strategies targeting this aspect are underexplored. This study investigates the use of sucralfate, a mucosal protective agent, as an adjunctive therapy in sepsis management, aiming to improve patient outcomes. Methods A retrospective cohort analysis was conducted using data from the MIMIC-IV database. We included adults with sepsis admitted to the ICU, comparing those who received early sucralfate (within 72 hours) with those who did not, adjusting for confounders via propensity score matching (PSM). The primary outcome was ICU mortality, with secondary outcomes including in-hospital mortality and ICU and hospital length of stay. Results Of 22,155 sepsis patients, 418 received sucralfate. The ICU mortality in the non-sucralfate group was 11.4%, while the sucralfate group showed significantly lower mortality (4.8%). Similarly, hospital mortality was 16.5% in the non-sucralfate group, compared to 9.1% in the sucralfate group. In the matched cohort, odds ratios indicated that sucralfate use was associated with reduced ICU mortality (OR 0.46, 95%CI 0.24–0.86, p = 0.018) and in-hospital mortality (OR 0.57, 95%CI 0.35–0.91, p = 0.020). Conclusion Early administration of sucralfate may improve outcomes in sepsis. Further multicenter, prospective studies are needed to validate these findings and explore its potential integration into sepsis management.