Time-dependent association between colchicine administration and 28-day mortality in critically ill patients with sepsis: A propensity score-matched cohort study
In brief
Colchicine started after ICU admission halves 28-day sepsis mortality
In a propensity-matched analysis of 25,000 septic ICU patients, those who began colchicine more than 24 hours after admission had about a 50 percent lower risk of dying within 28 days compared with matched controls. The benefit was not seen in patients already on colchicine before ICU, and treatment was linked to more thrombocytopenia and longer hospital stays, highlighting the need for prospective trials.
- Journal
- Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy (Q2)
- Published
- 10 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Yucheng Zhou, Dongxia Xu, Yimeng Li, Gangjun Zong
- PMID
- 42575247
- DOI
- 10.1016/j.jiac.2026.103049
Why clinicians should know about it
- Picked for Microbiology (medical) (top studies of the week, 16 August 2026): High-quality evidence in a top journal
Abstract
OBJECTIVE: To evaluate the association between colchicine administration and 28-day mortality in septic patients while assessing its real-world safety profile. METHODS: This retrospective study utilized the MIMIC-IV (v3.1) database to identify adults meeting Sepsis-3.0 criteria. We employed 1:2 propensity score matching (PSM) and a time-dependent Cox proportional hazards model to mitigate immortal time bias. Exposure was stratified into new users (therapy initiated >24 h after ICU admission) and pre-ICU users (maintenance therapy). RESULTS: Among 25,119 patients, 434 received colchicine. After PSM (423 users, 835 controls), colchicine was associated with a significantly lower risk of 28-day mortality (hazard ratio [HR], 0.47; 95% confidence interval [CI], 0.26 - 0.87; P = 0.016). This observed survival association was concentrated among new users (HR, 0.26; 95% CI, 0.13 - 0.51; P < 0.001), whereas no significant advantage was observed for pre-ICU users (P = 0.168). While risks for acute kidney injury and hepatotoxicity were comparable, colchicine recipients had a higher incidence of thrombocytopenia (17.3% vs. 12.9%; P = 0.016). Hospital length of stay was significantly longer in the colchicine group compared to controls (median, 10.75 vs. 8.43 days; P < 0.001). CONCLUSIONS: Colchicine administration exhibits a significant survival association in patients with sepsis, with lower 28-day mortality risks observed primarily when initiated during the acute phase. However, these retrospective findings are purely hypothesis-generating, and prospective randomized controlled trials are essential to validate these clinical implications.
Abstract as published, via PubMed.
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