Premorbid \u03b21-selective (but not non-selective) \u03b2-blocker exposure reduces intensive care unit mortality among septic patients

Ming-Jen Kuo,Shing-Jong Lin,Jiun-Yu Guo,Cheng-Hsueh Wu,Ruey-Hsing Chou,Ya-Wen Lu,Po-Hsun Huang,Yi-Lin Tsai

doi:10.1186/s40560-021-00553-9

Abstract

Backgroundβ-blockers may protect against catecholaminergic myocardial injury in critically ill patients. Long-term β-blocker users are known to have lower lactate concentrations and favorable sepsis outcomes. However, the effects of β1-selective and nonselective β-blockers on sepsis outcomes have not been compared. This study was conducted to investigate the impacts of different β-blocker classes on the mortality rate in septic patients.MethodsWe retrospectively screened 2678 patients admitted to the medical or surgical intensive care unit (ICU) between December 2015 and July 2017. Data from patients who met the Sepsis-3 criteria at ICU admission were included in the analysis. Premorbid β-blocker exposure was defined as the prescription of any β-blocker for at least 1 month. Bisoprolol, metoprolol, and atenolol were classified as β1-selective β-blockers, and others were classified as nonselective β-blockers. All patients were followed for 28 days or until death.ResultsAmong 1262 septic patients, 209 (16.6%) patients were long-term β-blocker users. Patients with premorbid β-blocker exposure had lower heart rates, initial lactate concentrations, and ICU mortality. After adjustment for disease severity, comorbidities, blood pressure, heart rate, and laboratory data, reduced ICU mortality was associated with premorbid β1-selective [adjusted hazard ratio, 0.40; 95% confidence interval (CI), 0.18–0.92; P = 0.030], but not non-selective β-blocker use.ConclusionPremorbid β1-selective, but not non-selective, β-blocker use was associated with improved mortality in septic patients. This finding supports the protective effect of β1-selective β-blockers in septic patients. Prospective studies are needed to confirm it.

Highlights

Sepsis, defined as organ dysfunction caused by a dysregulated host response to infection [1], is a leading cause of death in the intensive care unit (ICU)
Hypertension, diabetes mellitus, end-stage renal disease (ESRD), cirrhosis, heart failure, arrhythmia, and coronary artery disease were more prevalent among subjects with premorbid βblocker exposure
In the multivariate regression analysis adjusted for age, APACHE Acute Physiology and Chronic Health Evaluation II (II) score, hypertension, diabetes, hematological malignancy, heart rate (HR), mean blood pressure (BP), and white blood cell count, β1-selective βblocker exposure remained associated independently with lesser ICU mortality

Summary

Introduction

Sepsis, defined as organ dysfunction caused by a dysregulated host response to infection [1], is a leading cause of death in the intensive care unit (ICU). Despite significant advances in intensive care medicine, septic shock mortality rates remain high, ranging from 40 to 50% [1]. More knowledge of the pathophysiology of sepsis is needed. Overwhelming inflammation, arterial vasodilation, and hypovolemia are the main components of the early phase of sepsis. Sympathetic activation is triggered to maintain systemic perfusion and oxygen delivery to vital organs. Adverse effects of catecholamine overactivation in sepsis include tachycardia-induced myocardial damage [2], inflammatory cytokine production [3], insulin resistance [4], and thrombogenicity [5]. Tachycardia occurring with sepsis can increase the cardiac workload and result in myocardial oxygen consumption

Methods

Results

Conclusion