Department of Respiratory and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China.
Department of Mathematics and Physics, North China Electric Power University-Baoding, Baoding 071003, China.
Medicina (Kaunas). 2022 Dec 15;58(12):1843. doi: 10.3390/medicina58121843.
Previous studies have suggested that long-term β-blocker therapy before sepsis is associated with reduced mortality. Sepsis-associated coagulopathy (SAC) remains a common complication in patients with sepsis and is associated with increased mortality. Adrenergic pathways are involved in the regulation of the coagulation system. Pre-existing long-term β-blocker therapy may have potentially beneficial effects on SAC and has yet to be well characterized. We aimed to assess the potential association between pre-existing long-term β-blocker therapy and the outcomes of patients with SAC. This study retrospectively screened the clinical data of adult patients with SAC admitted to the Intensive Care Unit (ICU) and respiratory ICU between May 2020 and October 2022. Patients with SAC who took any β-blocker for at least one year were considered pre-existing long-term β-blocker therapy. All enrolled patients were followed up for 28 days or until death. Among the 228 SAC patients, 48 received long-term β-blocker therapy before septic episodes. Pre-existing long-term β-blocker therapy was associated with reduced vasopressor requirements and a decreased 28-day mortality (log-rank test: = 0.041). In particular, long-term β-blocker therapy was related to substantially lower D-dimer levels and a trend of improved activated partial thromboplastin time in patients with SAC during initial ICU admission. Multivariable regression analysis showed that long-term β-blocker therapy was significantly and independently associated with a 28-day mortality among patients with SAC (adjusted odds ratio, 0.55; 95% confidence interval, (0.32-0.94); = 0.030). Pre-existing long-term β-blocker therapy might be associated with reduced vasopressor requirements and a decreased 28-day mortality among patients with SAC, providing evidence for the protective effect of β-blockers against SAC in managing sepsis.
先前的研究表明，脓毒症前长期使用β受体阻滞剂治疗与降低死亡率有关。脓毒症相关性凝血病（SAC）仍然是脓毒症患者的常见并发症，并与死亡率增加有关。肾上腺素能途径参与凝血系统的调节。预先存在的长期β受体阻滞剂治疗可能对 SAC 具有潜在的有益作用，但尚未得到很好的描述。我们旨在评估预先存在的长期β受体阻滞剂治疗与 SAC 患者结局之间的潜在关联。
这项研究回顾性筛选了 2020 年 5 月至 2022 年 10 月期间入住重症监护病房（ICU）和呼吸 ICU 的成人 SAC 患者的临床数据。患有 SAC 且至少服用β受体阻滞剂 1 年的患者被认为是预先存在的长期β受体阻滞剂治疗。所有纳入的患者均随访 28 天或直至死亡。
在 228 例 SAC 患者中，48 例在脓毒症发作前接受了长期β受体阻滞剂治疗。预先存在的长期β受体阻滞剂治疗与降低血管加压素需求和降低 28 天死亡率相关（对数秩检验： = 0.041）。特别是，在 SAC 患者最初入住 ICU 期间，长期β受体阻滞剂治疗与 D-二聚体水平显著降低和活化部分凝血活酶时间改善趋势相关。多变量回归分析表明，长期β受体阻滞剂治疗与 SAC 患者 28 天死亡率显著相关（调整优势比，0.55；95%置信区间，（0.32-0.94）； = 0.030）。
预先存在的长期β受体阻滞剂治疗可能与 SAC 患者的血管加压素需求降低和 28 天死亡率降低相关，为β受体阻滞剂在治疗脓毒症中对 SAC 的保护作用提供了证据。
