Previous prescription of β-blockers is associated with reduced mortality among patients hospitalized in intensive care units for sepsis

Objectives: Results from basic science and narrative reviews suggest a potential role of beta-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 beta-blocker therapy had a different mortality rate than those who did not receive treatment. Setting: 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. Interventions: None. Measurements and Main 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 beta-blockers and 8404 were not previously treated. Despite a higher risk profile, patients previously prescribed with beta-blockers hadlower 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 beta-blocker prescription and mortality in patients with sepsis. Chronic prescription of beta-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. (Crit Care Med 2012; 40:2768-2772)