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

Abstract

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.

Levosimendan in intensive care and emergency medicine: literature update and expert recommendations for optimal efficacy and safety

“…Liu et al [26] conjecture that downregulation of beta-receptors in sepsis may attenuate the increase in CI caused by dobutamine and suggest that, while the dose of dobutamine used in the studies they identified (5 μg/kg/min) may therefore be insufficient in this setting, any higher dose may come with an increased risk of cardiac arrhythmias. We also note data indicating a survival benefit from beta-blockers in sepsis [32,33]; this implies an adverse impact of betaadrenergic activity on survival in sepsis that might be addressed (at least in part) by avoiding dobutamine and reducing noradrenaline in favour of levosimendan.…”

Critical Influenza and COVID-19—A Comparative Nationwide Case-Control Study

“…Use of β-blockers was associated with a reduced risk of critical COVID-19 but not influenza in our study. Premorbid use of β-blockers has been associated with improved outcomes in sepsis ( 50 ), and recently, a small randomized study showed that inhospital treatment with metoprolol improved gas exchange in COVID-19–induced ARDS ( 51 ).…”

Premorbid beta blockade in sepsis is associated with a lower risk of a lactate concentration above the lactate threshold, a retrospective cohort study

“…Five observational studies have assessed the effect of pre-morbid beta-blockade on lactate levels in patients presenting with sepsis 39 – 43 . Three trials found a significant reduction in lactate levels with beta-blockade 39 , 41 , 43 , while two showed no difference 40 , 42 . A recent meta-analysis of these studeis found lactate levels to be lower in patients on beta-blockers 44 .…”