门诊使用β受体阻滞剂与脓毒症患者生存率：来自医疗保险受益人的全国队列研究结果
Outpatient beta-blockers and survival from sepsis: Results from a national cohort of Medicare beneficiaries.
作者信息
Singer Kathleen E, Collins Courtney E, Flahive Julie M, Wyman Allison S, Ayturk M Didem, Santry Heena P
机构信息
Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA.
Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
出版信息
Am J Surg. 2017 Oct;214(4):577-582. doi: 10.1016/j.amjsurg.2017.06.007. Epub 2017 Jun 24.
BACKGROUND
Elderly Americans suffer increased mortality from sepsis. Given that beta-blockers have been shown to be cardioprotective in critical care, we investigated outpatient beta-blocker prescriptions and mortality among Medicare beneficiaries admitted for sepsis.
METHODS
We queried a 5% random sample of Medicare beneficiaries for patients admitted with sepsis. We used in-hospital and outpatient prescription drug claims to compare in-hospital and 30-day mortality based on pre-admission beta-blocker prescription and class of beta-blocker prescribed using univariate tests of comparison and multivariable logistic regression models and another class of medications for control.
RESULTS
Outpatient beta-blocker prescription was associated with a statistically significant decrease in in-hospital and 30-day mortality. In multivariable modeling, beta-blocker prescription was associated with 31% decrease in in-hospital mortality and 41% decrease in 30-day mortality. Both cardioselective and non-selective beta-blockers conferred mortality benefit.
CONCLUSIONS
Our data suggests that there may be a role for preadmission beta-blockers in reducing sepsis-related mortality.
背景
美国老年人因脓毒症导致的死亡率增加。鉴于β受体阻滞剂在重症监护中已被证明具有心脏保护作用，我们调查了因脓毒症入院的医疗保险受益人的门诊β受体阻滞剂处方情况及死亡率。
方法
我们从医疗保险受益人中抽取5%的随机样本，以查找脓毒症入院患者。我们使用住院和门诊处方药索赔数据，通过比较的单变量检验以及多变量逻辑回归模型，根据入院前β受体阻滞剂处方情况和所开具的β受体阻滞剂类别，比较住院死亡率和30天死亡率，并以另一类药物作为对照。
结果
门诊β受体阻滞剂处方与住院死亡率和30天死亡率在统计学上显著降低相关。在多变量建模中，β受体阻滞剂处方与住院死亡率降低31%以及30天死亡率降低41%相关。心脏选择性和非选择性β受体阻滞剂均具有降低死亡率的作用。
结论
我们的数据表明，入院前使用β受体阻滞剂可能在降低脓毒症相关死亡率方面发挥作用。
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