[Autonomic dysfunction and beta-adrenergic blockers in multiple organ dysfunction syndrome].
OBJECTIVE
The multiple organ dysfunction syndrome (MODS), a failure of two or more organ systems, is the endstage of initial trigger events in diseases such as acute coronary syndrome or sepsis. The mortality is high (40 - 60 %). The present study aimed to detect whether beta-adrenergic blockers (BAB) which may affect sympathetic-parasympathetic balance have a positive influence on outcome.


METHODS
Data on 157 patients with MODS (83 male, 74 female, mean age 61.3 +/- 13.4 years) were retrospectively analysed concerning BAB medication and autonomic dysfunction. A 24-hour-Holter-ECG which had been applied within the initial 48 hours of illness was analysed for heart rate variability (HRV). All patients were followed to determine 28-day mortality.


RESULTS
69 of the 157 MODS patients had received BAB. This treatment was associated with a higher survival probability (hazard ratio [HR] 0.4, 95 % confidence interval [CI] 0.23 - 0.68; p = 0.001). Survival benefit was especially seen in the subgroup of MODS patients who had an ischemically triggered MODS (HR 0.2 [0.1 - 0.5], p = 0.001). HRV was less reduced in the BAB group compared to patients without this medication.


CONCLUSIONS
MODS patients treated with beta-adrenercic blockers may have a survival benefit which is especially seen in the subgroup of MODS patients with ischemically triggered MODS. Moreover, BAB medication is associated with a less pronounced autonomic dysfunction in MODS (especially the vagal modulation of heart rate) which might result in a lower inflammatory response. Hence, future prospective studies have to show the relevance of beta-adrenergic blockers in MODS.
Hennen
R
R
Universitätsklinik und Poliklinik für Innere Medizin III, Martin-Luther-Universität Halle-Wittenberg.
Friedrich
I
I
Hoyer
D
D
Nuding
S
S
Rauchhaus
M
M
Schulze
M
M
Schlisske
S
S
Schwesig
R
R
Schlitt
A
A
Buerke
M
M
Müller-Werdan
U
U
Werdan
K
K
Schmidt
H
H
D000319:Adrenergic beta-Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D001341:Autonomic Nervous System / Q000187:drug effects* / Q000502:physiology; D015716:Electrocardiography, Ambulatory; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology*; D012189:Retrospective Studies
D000319:Adrenergic beta-Antagonists