• Alejandro Macchia, Marilena Romero, Pablo Dino Comignani, Javier Mariani, Antonio D'Ettorre, Nadia Prini, Mariano Santopinto, and Gianni Tognoni.
• Laboratory of Pharmacoepidemiology, Consorzio Mario Negri Sud, Santa Maria Imbaro, Italy. macchia@negrisud.it
• Crit. Care Med.. 2012 Oct 1;40(10):2768-72.

ObjectivesResults 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.SettingRecord 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.InterventionsNone.Measurements And Main ResultsWe 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.ConclusionsAs 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.

15 keywords...

hide…