Effect of premorbid beta-blocker treatment on cardiac function and clinical outcomes in septic patients: a retrospective study

Background Beta-blocker showed beneficial effects in sepsis in recent years. However, due to its impact on hemodynamics, the use of beta-blocker in sepsis was limited. Therefore, large clinical observations are needed to corroborate the effects of beta-blocker in sepsis. Our study aims to determine whether premorbid treatment of beta-blocker is associated with the improvement of cardiac function and clinical outcomes in patients with sepsis. Methods The single-centered, retrospective cohort study was conducted in a university hospital intensive care unit (ICU) between August 2022 and March 2024. All patients with sepsis were included in the study. Exclusion criteria were age < 18 years, short hospitalization duration of less than 48h, a past history of severe significant underlying cardiac conditions, and incomplete records. The primary outcomes were myocardial injury markers, echocardiography and electrocardiogram indices to determine cardiac function. The secondary outcome was mortality. Results Among 1005 patients with sepsis, 228 patients received premorbid beta-blocker treatment. There was no difference in disease severity including Sequential Organ Failure Assessment (SOFA) score and Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score at baseline between groups. Patients with premorbid beta-blocker exposure had lower cardiac troponin I (TnI, 87.9 [IQR, 23.4–306.0] vs 142.0 [IQR, 37.8-481.2]), lactic dehydrogenase (LDH, 274.0 [IQR, 175.0-496.0] vs 319.0 [IQR, 229.0-456.8]), and B-type natriuretic peptide (BNP, 267.9 [IQR, 118.1-1065.1] vs 509.3 [IQR, 184.8–1203.0]). Measured by echocardiography, premorbid beta-blocker exposure exhibited an association with increased left ventricular ejection fraction (LVEF, 58% [IQR 52–60] vs 55% [IQR 50–60]), reduced left ventricular end diastolic diameter (LVEDD, 4.3 [IQR 4.2–4.6] vs 4.5 [IQR 4.3–4.8]), and right atrial diameter (RAD, 3.3 [IQR 3.2–3.6] vs 3.4 [IQR 3.3–3.7]). Premorbid beta-blocker exposure was associated with lower 14-day (13.6% [IQR 9.1–18.1] vs 21.5% [IQR 18.6–24.4]), 28-day (17.5% [IQR 12.6–22.5] vs 27.4% [IQR 24.3–30.6]) and in-hospital (18.9% [IQR 13.7–24.0] vs 28.8% [IQR 25.6–32.0]) mortality. Conclusions For septic patients, premorbid beta-blocker treatment preserved cardiac function and reduced mortality. These results support the need for prospective or randomized clinical trials to confirm the cardio-protective effects of the administration of beta-blocker in sepsis.