1351: Effect of Preadmission Beta-Blocker Use on Outcomes of Patients Admitted With Septic Shock

Sharma, Abhishek; Vashisht, Rishik; Bauer, Seth; Hanane, Tarik

doi:10.1097/01.ccm.0000510025.15232.50

Cited by 3 publications

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“…One study (Alsolamy et al) included patients ≥ 14 years of age; all other studies included adult (18 years and above) patients. Four studies by Sharma et al, Charles et al, Alsolamy et al, and Al-Qadi et al were reported as conference abstracts [22–25]. The characteristics of the studies are appended (Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…ICD-9-CM coding was used.Second episode of sepsis.33,2131040Fuchs et al [26]2017Secondary analysis of prospective observational single-centre trial2010–2013Germany1Sepsis, severe sepsis, septic shockICUSurgicalPrimary: mortality; survival analysisSecondary: length of stayPre-existing oral beta blocker therapy was defined as a treatment started at least 7 days before sepsis onset.First episode of severe sepsis or septic shock.< 18 years old, no infection, no chronic beta blocker therapy, no sepsis or septic shock, second episode of sepsis.296296Contenti et al [21]2015Retrospective cohort study2012–2014France1Severe sepsis, septic shockED/ICU–Primary: initial blood lactate concentration.Secondary: mortality‘Premorbid’ not defined. Data obtained from ED observation data or inpatient records> 18 years old, severe sepsis, septic shock.–26065Sharma et al [25]2016Retrospective study2013–2014ICUNot specifiedSeptic shockICUMedicalPeak lactate, cumulative norepinephrine dose and duration, mortality‘Premorbid’ not defined. Data obtained from ICU medical records.Medical ICU, septic shock, vasopressors required.–12348Charles et al [23]2018Retrospective study2008–2016FranceNot specifiedSeptic shockICU–Heart rate, arterial lactate levels, arterial oxygen content, fluid requirements, norepinephrine requirements, duration of mechanical ventilation, mortality‘Premorbid’ not defined.Adult patients diagnosed with septic shock within 48 h.–938230Alsolamy et al [22]2016Retrospective cohort study1/1/2003–31/12/2013Saudi Arabia1Severe sepsis, septic shockICU–Primary: mortalityActive prescription 3 months prior to admission.> 14 years old, severe sepsis and septic shock, previous prescription of beta blockers active for 3 months prior to hospital admission.–4629623Al-Qadi et al [24]2014Retrospective study2007–2009USA1Severe sep...…”

Section: Resultsmentioning

confidence: 99%

“…Five studies included in this review [10, 11, 24, 26, 27] were judged to be of moderate risk of bias for the primary outcome of mortality as they reported adjustment of confounding variables via statistical analysis. Four studies [21–23, 25] were judged as having serious risk of bias due to confounding as the authors did not perform statistical analysis to correct for confounders. The risk of bias assessment using ROBINS-1 tool for each trial is appended (Additional file 5: Figure S2) with reasonings attached (Additional file 3: Table S3).…”

Section: Resultsmentioning

confidence: 99%

“…of patients with no premorbid beta blocker useNo. of patients with premorbid beta blocker useMortality census dayMortality90-day mortality28-day mortalityICU mortalityHospital mortalitySurvival analysisOutcomeAdjustment methodAdjusted variablesSinger et al [11]683940012838Hospital mortality––––aOR = 0.69 (CI 0.62–0.77)–Premorbid beta blocker usage is significantly associated with decreased mortalityMultivariate logistic regressionAge, class of beta blocker, congestive heart failure, cancer, surgical proceduresMacchia et al [10]94658404106128-day mortality––aOR = 0.81 (CI 0.68–0.97), p = 0.025–––Premorbid beta blocker usage is significantly associated with decreased mortalityMultivariate logistic regressionAge, sex, history of hypertension, dyslipidaemia, diabetes mellitus, myocardial infarction, congestive heart failure, atrial fibrillation, chronic obstructive pulmonary disease, depression, and malignancyHsieh et al [27]33,21332,1731040Hospital mortality––––aOR = 0.89 (CI 0.76–1.04), p = 0.1484–Premorbid beta blocker usage is not significantly associated with decreased mortalityMultivariate logistic regressionAge, sex, insurance premium, urbanization level, and comorbiditiesFuchs et al a [26]2960296ICU, hospital, 28 days, 90 days–40.7% vs. 52.7%, p = 0.046 a 28.7% vs. 41.1%, p = 0.04 a 27.5% vs. 38%, p = 0.06 a 35.3% vs. 48.1%, p = 0.03 a HR = 0.67 (CI 0.48, 0.95), p = 0.03 a Continuation of beta-blockade is associated with decreased 28-day, 90-day, and hospital mortality.Multivariate cox regressionSex, known nosocomial pathogen, chronic diseases, body temperature (< 36.0 °C), APACHE II score first 24 h, lactate first 24 h (> 3 mmol/L)Contenti et al [21]2601956528-day mortality––––35% vs 49%, p = 0.08–Premorbid beta blocker usage is not significantly associated with decreased mortality––Sharma et al [25]12375…”

Section: Resultsmentioning

confidence: 99%

“…Only four studies by Contenti et al [21], Charles et al [23], Sharma et al [25], and Fuchs et al [26] provided clinical parameter data. However, reporting of parameters was inconsistent.…”

Section: Resultsmentioning

confidence: 99%

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The association between premorbid beta blocker exposure and mortality in sepsis—a systematic review

et al. 2019

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Background The effect of premorbid β-blocker exposure on clinical outcomes in patients with sepsis is not well characterized. We aimed to examine the association between premorbid β-blocker exposure and mortality in sepsis. Methods EMBase, MEDLINE, and Cochrane databases were searched for all studies of premorbid β-blocker and sepsis. The search was last updated on 22 June 2019. Two reviewers independently assessed, selected, and abstracted data from studies reporting chronic β-blocker use prior to sepsis and mortality. Main data extracted were premorbid β-blocker exposure, mortality, study design, and patient data. Two reviewers independently assessed the risk of bias and quality of evidence. Results In total, nine studies comprising 56,414 patients with sepsis including 6576 patients with premorbid exposure to β-blockers were eligible. For the primary outcome of mortality, two retrospective studies reported adjusted odds ratios showing a reduction in mortality with premorbid β-blocker exposure. One study showed that premorbid β-blocker exposure decreases mortality in patients with septic shock. Another study showed that continued β-blockade during sepsis is associated with decreased mortality. Conclusion This systematic review suggests that β-blocker exposure prior to sepsis is associated with reduced mortality. There was insufficient data to conduct a bona fide meta-analysis. Whether the apparent reduction in mortality may be attributed to the mitigation of catecholamine excess is unclear. Trial registration PROSPERO, CRD42019130558 registered June 12, 2019. Electronic supplementary material The online version of this article (10.1186/s13054-019-2562-y) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Only four studies by Contenti et al [21], Charles et al [23], Sharma et al [25], and Fuchs et al [26] provided clinical parameter data. However, reporting of parameters was inconsistent.…”

Section: Resultsmentioning

confidence: 99%

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The association between premorbid beta blocker exposure and mortality in sepsis—a systematic review

et al. 2019

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Association Between Premorbid Beta-Blocker Exposure and Sepsis Outcomes—The Beta-Blockers in European and Australian/American Septic Patients (BEAST) Study

Tan

Harazim

Simpson

et al. 2021

Critical Care Medicine

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OBJECTIVES: To examine the effect of premorbid β-blocker exposure on mortality and organ dysfunction in sepsis. DESIGN: Retrospective observational study. SETTING: ICUs in Australia, the Czech Republic, and the United States. PATIENTS: Total of 4,086 critical care patients above 18 years old with sepsis between January 2014 and December 2018. INTERVENTION: Premorbid beta-blocker exposure. MEASUREMENTS AND MAIN RESULTS: One thousand five hundred fifty-six patients (38%) with premorbid β-blocker exposure were identified. Overall ICU mortality rate was 15.1%. In adjusted models, premorbid β-blocker exposure was associated with decreased ICU (adjusted odds ratio, 0.80; 95% CI, 0.66–0.97; p = 0.025) and hospital (adjusted odds ratio, 0.83; 95% CI, 0.71–0.99; p = 0.033) mortality. The risk reduction in ICU mortality of 16% was significant (hazard ratio, 0.84, 95% CI, 0.71–0.99; p = 0.037). In particular, exposure to noncardioselective β-blocker before septic episode was associated with decreased mortality. Sequential Organ Failure Assessment score analysis showed that premorbid β-blocker exposure had potential benefits in reducing respiratory and neurologic dysfunction. CONCLUSIONS: This study suggests that β-blocker exposure prior to sepsis, especially to noncardioselective β blockers, may be associated with better outcome. The findings suggest prospective evaluation of β-blocker use in the management of sepsis.

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Impact of premorbid use of beta‑blockers on survival outcomes of patients with sepsis: A systematic review and meta‑analysis

Chu,

Fei,

et al. 2024

Exp Ther Med

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It is unclear if premorbid use of beta-blockers affects sepsis outcomes. The present systematic review aimed to assess the impact of premorbid beta-blocker use on mortality and the need for mechanical ventilation in patients with sepsis. Embase, Scopus, PubMed and Web of Science were searched for studies comparing outcomes of patients with sepsis based on the premorbid use of beta-blockers. The primary outcome was mortality, and the secondary outcome was the need for mechanical ventilation. The results were reported as odds ratios (ORs) with 95% confidence intervals (CIs). A total of 17 studies including 64,586 patients with sepsis were included. Of them, 8,665 patients received premorbid beta-blockers and 55,921 patients were not treated with premorbid beta-blockers and served as a control group. Pooled analysis of mortality rates revealed that premorbid use of beta-blockers did not affect in-hospital mortality (OR: 0.96; 95% CI: 0.78, 1.18; and I 2 =63%) but significantly reduced one-month mortality rates (OR: 0.83; 95% CI: 0.72, 0.96; and I 2 =63%). Combined analysis of adjusted data showed that premorbid beta-blockers were associated with a significant survival advantage in patients with sepsis (OR: 0.81; 95% CI: 0.72, 0.92; and I 2 =70%). However, there was no effect of premorbid use of beta-blockers on the need for mechanical ventilation (OR: 0.93; 95% CI: 0.66, 1.30); and I 2 =72%). The results of the present study indicated that premorbid use of beta-blockers is associated with improved survival in patients with sepsis. However, it does not impact the need for mechanical ventilation. The results should be interpreted with caution as the data is observational and unadjusted.

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1351: Effect of Preadmission Beta-Blocker Use on Outcomes of Patients Admitted With Septic Shock

Cited by 3 publications

References 0 publications

The association between premorbid beta blocker exposure and mortality in sepsis—a systematic review

The association between premorbid beta blocker exposure and mortality in sepsis—a systematic review

Association Between Premorbid Beta-Blocker Exposure and Sepsis Outcomes—The Beta-Blockers in European and Australian/American Septic Patients (BEAST) Study

Impact of premorbid use of beta‑blockers on survival outcomes of patients with sepsis: A systematic review and meta‑analysis

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