title: Previous prescription of β-blockers is associated with reduced mortality among patients hospitalized in intensive care units for sepsis.
abstract: OBJECTIVE
  Results 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.
  
  
  METHODS
  Record 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.
  
  
  METHODS
  None.
  
  
  RESULTS
  We 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.
  
  
  CONCLUSIONS
  As 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.
authors: Laboratory of Pharmacoepidemiology, Consorzio Mario Negri Sud, Santa Maria Imbaro, Italy. macchia@negrisud.it
authors: Alejandro
authors: A
authors: Macchia
authors: Marilena
authors: M
authors: Romero
authors: Pablo Dino
authors: PD
authors: Comignani
authors: Javier
authors: J
authors: Mariani
authors: Antonio
authors: A
authors: D'Ettorre
authors: Nadia
authors: N
authors: Prini
authors: Mariano
authors: M
authors: Santopinto
authors: Gianni
authors: G
authors: Tognoni
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004363:Drug Utilization; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D018805:Sepsis / Q000401:mortality*; D012737:Sex Factors
chemical_list: D000319:Adrenergic beta-Antagonists