β受体阻滞剂与危重症充血性心力衰竭患者1年死亡率降低相关,且在不同亚组中有不同益处。
Beta blockers linked to reduced 1-Year mortality in critically ill congestive heart failure patients with differential benefits across subgroups.
作者信息
Wang Kai, Zhang Haitao, Chen Yanming
机构信息
Department of Cardiology, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 401336, China.
出版信息
Sci Rep. 2025 Sep 2;15(1):32263. doi: 10.1038/s41598-025-17483-3.
The efficacy of beta (β) blockers in critically ill patients with congestive heart failure (CHF) remains uncertain. This study investigated the association of β blockers use with 1-year all-cause mortality in these patients. Utilizing a retrospective cohort, the Medical Information Mart in Intensive Care-Ⅳ database, we identified critically ill CHF patients between 2008 and 2022. Stratified by β blockers use, Kaplan-Meier survival analysis and Cox models examined the association. Subgroup analyses investigated its effect across various patient characteristics. It comprised 13,908 eligible patients, of whom 74.3% received β blockers. β blockers use was associated with a reduction in mortality (HR: 0.51, 95% CI: 0.49-0.54, p < 0.001). Subgroup analyses revealed more benefits in non-elderly, male, hypertensive, diabetic or sepsis patients, as well as those undergoing mechanical ventilation or continuous renal replacement therapy (CRRT). Patients with elevated baseline heart rates or reduced left ventricular ejection fraction (LVEF) experienced greater benefits (p for interaction < 0.001). Additionally, selective β1 blockers offered superior survival benefits than non-selective β blockers in patients with LVEF of 50% or higher, and these benefits were pronounced in those with elevated baseline white blood cell counts (p for interaction = 0.022). The use of β blockers was linked to a reduction of all-cause mortality in critically ill patients with CHF, particularly in subgroups characterized by younger age, male gender, hypertension, diabetes, sepsis, undergoing CRRT or mechanical ventilation, and those exhibiting elevated baseline heart rates or reduced LVEF. These findings are potentially influenced by unmeasured confounders and need to be confirmed by prospective randomized controlled trials.
β受体阻滞剂在重症充血性心力衰竭(CHF)患者中的疗效仍不确定。本研究调查了这些患者使用β受体阻滞剂与1年全因死亡率之间的关联。利用回顾性队列研究,即重症监护-IV数据库中的医学信息集市,我们确定了2008年至2022年期间的重症CHF患者。按β受体阻滞剂使用情况分层,采用Kaplan-Meier生存分析和Cox模型来检验这种关联。亚组分析研究了其在各种患者特征中的作用。该研究纳入了13908名符合条件的患者,其中74.3%接受了β受体阻滞剂治疗。使用β受体阻滞剂与死亡率降低相关(风险比:0.51,95%置信区间:0.49 - 0.54,p < 0.001)。亚组分析显示,在非老年、男性、高血压、糖尿病或脓毒症患者,以及接受机械通气或连续性肾脏替代治疗(CRRT)的患者中,获益更多。基线心率升高或左心室射血分数(LVEF)降低的患者获益更大(交互作用p < 0.001)。此外,在LVEF为50%或更高的患者中,选择性β1受体阻滞剂比非选择性β受体阻滞剂具有更好的生存获益,且这些获益在基线白细胞计数升高的患者中更为明显(交互作用p = 0.022)。使用β受体阻滞剂与降低重症CHF患者的全因死亡率有关,特别是在年龄较轻、男性、高血压、糖尿病、脓毒症、接受CRRT或机械通气,以及基线心率升高或LVEF降低的亚组中。这些发现可能受到未测量的混杂因素影响,需要前瞻性随机对照试验予以证实。