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Previous prescription of β-blockers is associated with reduced mortality among patients hospitalized in intensive care units for sepsis.

Abstract

OBJECTIVES
Results from basic science and narrative reviews suggest a potential role of β-blockers in patients with sepsis. Although the hypothesis is physiologically appealing, it could be seen as clinically counterintuitive. We sought to assess whether patients previously prescribed chronic β-blocker therapy had a different mortality rate than those who did not receive treatment.
SETTING
Record linkage of administrative databases of Italian patients hospitalized for sepsis during years 2003-2008 were identified and followed up for all-cause mortality at 28 days.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
We identified 9,465 patients aged≥40 yrs who were hospitalized in critical care units for sepsis. Of these, 1,061 patients were on chronic prescription with β-blockers and 8404 were not previously treated. Despite a higher risk profile, patients previously prescribed with β-blockers had lower mortality at 28 days (188/1061 [17.7%]) than those previously untreated (1857/8404 [22.1%]) (odds ratio 0.78; 95% confidence interval 0.66-0.93; p=.005 for unadjusted analysis, and odds ratio 0.81; 95% confidence interval 0.68-0.97; p=.025 for adjusted analyses). Sensitivity and pair-matched results confirm the primary findings.
CONCLUSIONS
As far as we are aware, this pharmacoepidemiologic assessment is the largest to examine the potential association of previous β-blocker prescription and mortality in patients with sepsis. Chronic prescription of β-blockers may confer a survival advantage to patients who subsequently develop sepsis with organ dysfunction and who are admitted to an intensive care unit. Prospective randomized clinical trials should formally test this hypothesis.

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  • Publisher Full Text

    • Authors

    Macchia A, Romero M, Comignani PD, Mariani J, D'Ettorre A, Prini N, Santopinto M, Tognoni G

    Institution

    Laboratory of Pharmacoepidemiology, Consorzio Mario Negri Sud, Santa Maria Imbaro, Italy. macchia@negrisud.it

    Source

    Critical care medicine 40:10 2012 Oct pg 2768-72

    MeSH

    Adrenergic beta-Antagonists
    Age Factors
    Aged
    Aged, 80 and over
    Comorbidity
    Drug Utilization
    Female
    Humans
    Intensive Care Units
    Male
    Middle Aged
    Sepsis
    Sex Factors

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    22824934