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. 2021 May 13;9(1):40.
doi: 10.1186/s40560-021-00553-9.

Premorbid β1-selective (but not non-selective) β-blocker exposure reduces intensive care unit mortality among septic patients

Ming-Jen Kuo  1   2 , Ruey-Hsing Chou  1   2   3   4 , Ya-Wen Lu  1   2 , Jiun-Yu Guo  1   2 , Yi-Lin Tsai  1   2 , Cheng-Hsueh Wu  5   6 , Po-Hsun Huang  7   8   9   10 , Shing-Jong Lin  2   4   11   12   13
Affiliations

Premorbid β1-selective (but not non-selective) β-blocker exposure reduces intensive care unit mortality among septic patients

Ming-Jen Kuo et al. J Intensive Care. .

Abstract

Background: β-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.

Methods: We 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.

Results: Among 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.

Conclusion: Premorbid 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.

Keywords: Catecholamine; Intensive care unit; Sepsis; Tachycardia; β-blocker; β1-selective β-blocker.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of patient enrollment and classification
Fig. 2
Fig. 2
Kaplan–Meier curves of freedom from 30-day mortality in patients grouped by the status of premorbid beta-blocker (BB) usage
See this image and copyright information in PMC

References

    1. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) Jama. 2016;315(8):801–810. doi: 10.1001/jama.2016.0287. - DOI - PMC - PubMed
    1. Suzuki T, Suzuki Y, Okuda J, Kurazumi T, Suhara T, Ueda T, Nagata H, Morisaki H. Sepsis-induced cardiac dysfunction and β-adrenergic blockade therapy for sepsis. J Intensive Care. 2017;5(1):22. doi: 10.1186/s40560-017-0215-2. - DOI - PMC - PubMed
    1. Elenkov IJ, Wilder RL, Chrousos GP, Vizi ES. The sympathetic nerve--an integrative interface between two supersystems: the brain and the immune system. Pharmacol Rev. 2000;52(4):595–638. - PubMed
    1. Träger K, DeBacker D, Radermacher P. Metabolic alterations in sepsis and vasoactive drug-related metabolic effects. Curr Opin Crit Care. 2003;9(4):271–278. doi: 10.1097/00075198-200308000-00004. - DOI - PubMed
    1. Schouten M, Wiersinga WJ, Levi M, van der Poll T. Inflammation, endothelium, and coagulation in sepsis. J Leukoc Biol. 2008;83(3):536–545. doi: 10.1189/jlb.0607373. - DOI - PubMed

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