Β-Blockers, Tachycardia, and Survival Following Sepsis: An Observational Cohort Study. (18th January 2021)

• Record Type: Journal Article
• Authors: Guz, Dmitri; Buchritz, Shira; Guz, Alina; Ikan, Alon; Babich, Tania; Daitch, Vered; Gafter-Gvili, Anat; Leibovici, Leonard; Avni, Tomer
• Is Part Of: Clinical infectious diseases. Volume 73:Number 4(2021)
• Page Start: e921
• Page End: e926
• Publication Date: 2021-01-18
• Subjects: sepsis -- mortality -- beta-blockers -- tachycardia -- cohort; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciab034
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: Sepsis is associated with excessive release of catecholamines, which causes tachycardia and is correlated with poor clinical outcome. β-Blockers (BBs) may blunt this effect on heart rate (HR). The objective of this study is to assess whether long-term BB therapy is associated with better clinical outcomes in patients with sepsis admitted to internal medicine wards. Methods: We performed a single-center, observational cohort study. We included adult patients who were hospitalized in medicine departments due to sepsis. A propensity score model for BB therapy was used to match patients. The primary outcome was the 30-day all-cause mortality rate. A multivariate analysis was performed to identify risk factors for an adverse outcome. Patients were stratified according to absolute tachycardia (HR ≥100/min) or relative tachycardia at presentation (tachycardia index above the third quartile, with tachycardia index defined as the ratio of HR to temperature). Results: A total of 1186 patients fulfilled the inclusion criteria. In the propensity-matched cohort patients given BB treatment were younger (median age [interquartile range], 74 [62–82] vs 81 [68–87] years; P ≤ .001). BB treatment was associated with reduction in 30-day mortality rates for patients with absolute tachycardia (odds ratio, 0.406; 95% confidence interval, .177–.932). Final model with interaction variable of BB treatment with HR was associated with short-term survival (odds ratio, 0.38; 95% confidence interval, .148–.976). Selective BB therapy had a stronger protective effect than nonselective BB therapy. Conclusions: Long-term BB therapy was associated with decreased mortality rate in patients hospitalized with sepsis in internal medicine wards exhibiting absolute and relative tachycardia. Abstract : This observational cohort study suggests that tachycardia is an independent risk factor for mortality rate in patients with sepsis. We have demonstrated that long-term treatment with β-blockers is associated with a reduced mortality rate in patients with sepsis and tachycardia.