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

• DOI: 10.1097/ccm.0b013e31825b9509
• Publication Date: 2012-07-21T13:45:28Z
• Authors: Alejandro Macchia; Marilena Romero; Pablo Dino Comignani; Javier Mariani; Antonio D’Ettorre; Nadia Prini; Mariano Santopinto; Gianni Tognoni
• Keywords: Aged, 80 and over; Male; Adrenergic beta-Antagonists; Age Factors; Comorbidity; Middle Aged; Drug Utilization; 3. Good health; Intensive Care Units; 03 medical and health sciences; Sex Factors; 0302 clinical medicine; Sepsis; Humans; Female; Aged

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.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.None.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.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.