Mortality in septic patients treated with short-acting betablockers : a comprehensive meta-analysis of randomized controlled trials
Alexandru, Mihai-Gabriel Niewald, Patrick Krüger, Stefan Borgstedt, Rainer Whitehouse, Tony Singer, Mervyn Rehberg, Sebastian Scholz, Sean S
Alexandru, Mihai-Gabriel
Niewald, Patrick
Krüger, Stefan
Borgstedt, Rainer
Whitehouse, Tony
Singer, Mervyn
Rehberg, Sebastian
Scholz, Sean S
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2024-11-27
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Background: Treatment with short-acting betablockers in septic patients remains controversial. Two recent large multicenter trials have provided additional evidence on this therapeutic approach. We thus performed a meta-analysis, including the most recent data, to evaluate the potential impacts of treatment with short-acting betablockers on mortality in adult septic patients.
Methods: The data search included PubMed, Web of Science, ClinicalTrials.gov and the Cochrane Library. A meta-analysis of all eligible peer-reviewed studies was performed in accordance with the PRISMA statement. Only randomized, controlled studies with valid classifications of sepsis and intravenous treatment with short-acting betablockers (landiolol or esmolol) were included. Short-term mortality served as the primary endpoint. Secondary endpoints included effects on short-term mortality regarding patient age and cardiac rhythm.
Results: A total of seven studies summarizing 854 patients fulfilled the predefined criteria and were included. Short-term mortality as well as pooled mortality (longest period of data on mortality) was not significantly impacted by treatment with short-acting betablockers when compared to the reference treatment (Risk difference, - 0.10 [95% CI, - 0.22 to 0.02]; p = 0.11; p for Cochran's Q test = 0.001; I2 = 73%). No difference was seen when comparing patients aged < 65 versus ≥ 65 years (p = 0.11) or sinus tachycardia with atrial fibrillation (p = 0.27). Despite statistical heterogeneity, no significant publication bias was observed.
Conclusion: Administration of short-acting betablockers did not reduce short-term mortality in septic patients with persistent tachycardia. Future studies should also provide extensive hemodynamic data to enable characterization of cardiac function before and during treatment.
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Alexandru MG, Niewald P, Krüger S, Borgstedt R, Whitehouse T, Singer M, Rehberg S, Scholz SS. Mortality in septic patients treated with short-acting betablockers: a comprehensive meta-analysis of randomized controlled trials. Crit Care. 2024 Nov 27;28(1):392. doi: 10.1186/s13054-024-05174-w.
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