Previous prescription of ?-blockers is associated with reduced mortality among patients hospitalized in intensive care units for sepsis.
Crit Care Med. 2012 Oct;40(10):2768-72
Authors: Macchia A, Romero M, Comignani PD, Mariani J, D'Ettorre A, Prini N, Santopinto M, Tognoni G
OBJECTIVES: Results from basic science and narrative reviews suggest a potential role of ?-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 ?-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.
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 ?-blockers and 8404 were not previously treated. Despite a higher risk profile, patients previously prescribed with ?-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 ?-blocker prescription and mortality in patients with sepsis. Chronic prescription of ?-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.
PMID: 22824934 [PubMed - indexed for MEDLINE]