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

Abstract

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.

β-adrenergic blockade is associated with a reduced risk of 90-day mortality after surgery for hip fractures

“… 13 14 BB therapy has shown an association with reduced mortality in patients suffering from sepsis. 24 A systematic review by Tan et al , including nine studies with a total of 56 414 patients, investigated the effect of β-blockade on sepsis. The results of this systematic review suggest that BB therapy, prior to developing full-blown sepsis, is associated with significantly reduced mortality.…”

“…The results of this systematic review suggest that BB therapy, prior to developing full-blown sepsis, is associated with significantly reduced mortality. 24 Both in vivo and in vitro studies have shown that β-blockade downregulates the degree of circulating proinflammatory factors IL-6 and TNF-α, which could explain the drug’s beneficial use in acting as an inflammatory balancing agent. 12 13 25 …”

Beta‐Adrenergic Blockers as a Potential Treatment for COVID‐19 Patients

“…septic shock. [52,53] I suggest that norepinephrine should not be used in the treatment of COVID-19 patients with septic shock, instead beta-adrenergic blockers should be used.…”

Can beta-adrenergic blockers be used in the treatment of COVID-19?

“…It is known that COVID-19 patients exhibit pneumonia, and severe cases had complications like acute respiratory distress syndrome (ARDS), respiratory failure and septic shock which carries a high mortality rate [2]. Recent studies showed that beta-adrenergic blockers reduced the mortality in septic shock patients [3]. Beta-adrenergic blockers also showed beneficial effects in ARDS and respiratory failure patients [4,5].…”