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. 2025 Jun 16;20(6):e0325980.
doi: 10.1371/journal.pone.0325980. eCollection 2025.

Association between the early use of beta-blocker and the risk of sepsis-associated acute kidney injury: A retrospective cohort study using the MIMIC-IV database

Canmin Wang  1 , Yingfang Hu  1 , Yunfeng Song  1
Affiliations

Association between the early use of beta-blocker and the risk of sepsis-associated acute kidney injury: A retrospective cohort study using the MIMIC-IV database

Canmin Wang et al. PLoS One. .

Abstract

Background: Sepsis-associated acute kidney injury (SA-AKI) is a common and life-threatening complication in critically ill patients. Studies have shown that the use of beta-blockers improves hemodynamics and the risk of death in patients with sepsis. However, the association between beta-blockers use and the risk of AKI in patients with sepsis remains poorly understood. The present study aimed to evaluate this potential association.

Method: Sepsis patients for this retrospective cohort study were extracted from the Medical Information Mart for Intensive Care-IV (MIMIC) database. Propensity score matching (PSM) was used to balance the basic characteristics between beta-blocker users and non-users. Univariate and multivariable logistic regression analysis were employed to evaluate the association between early use of beta-blocker and SA-AKI. Odds ratio (OR) and 95% confidence interval (CI) were estimated as effect measurements.

Results: Totally 4,419 patients with sepsis were enrolled in our study. The follow-up period was from the 24th hour of intensive care unit (ICU) admission to the occurrence of AKI or ICU discharge, with 2,122 (48.02%) cases of developed AKI. After PSM, a lower SA-AKI risk was observed in the early use of the beta-blockers group compared to the non-user group (adjusted OR: 0.80; 95%CI: 0.64-0.99). Similar associations of early use of beta-blockers and SA-AKI were observed in patients younger than 65 years old, male, without comorbidities, and with Simplified Acute Physiology Score II/Charlson comorbidity index scores below the median (all P < 0.05).

Conclusion: In ICU patients with sepsis, early use of beta-blockers is associated with a reduced risk of AKI, which may help reduce renal impairment and improve survival. Further studies are needed to verify the underlying mechanisms of beta-blockers in the development of SA-AKI.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram of selecting eligible participants.
ICU, intensive care unit; MIMIC, Medical Information Mart for Intensive Care; eGFR, estimated glomerular filtration rate; RRT, renal replacement therapy; AKI, acute kidney injury.
Fig 2
Fig 2. Association of early use of beta-blocker with SA-AKI in different subgroups.
SA-AKI, sepsis-associated acute kidney injury; AMI, acute myocardial infarction; CKD, chronic kidney disease; SAPS II, Simplified Acute Physiology Score II; CCI, Charlson comorbidity index.
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