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The following is a summary of “Mortality in septic patients treated with short-acting betablockers: a comprehensive meta-analysis of randomized controlled trials,” published in the November 2024 issue of Critical Care by Alexandru et al.
The use of short-acting beta-blockers in patients with sepsis remains controversial, with 2 recent large multicenter trials offering further evidence of the treatment approach.
Researchers conducted a retrospective study to assess the impact of short-acting beta-blocker treatment on mortality in adult patients with sepsis through a meta-analysis incorporating the most recent data.
They searched across PubMed, Web of Science, ClinicalTrials.gov, and the Cochrane Library. A meta-analysis of eligible peer-reviewed studies was carried out by the PRISMA statement. Only randomized, controlled trials with valid sepsis classifications and intravenous short-acting beta-blocker treatment (landiolol or esmolol) were included. Short-term mortality was the primary endpoint, and secondary endpoints assessed mortality effects based on patient age and cardiac rhythm.
The results showed that 7 studies, including 854 patients, met the predefined criteria for inclusion. Treatment with short-acting beta-blockers did not significantly affect short-term or pooled mortality (longest available mortality data) 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 significant differences were found in mortality between patients aged <65 and ≥65 years (P = 0.11) or between those with sinus tachycardia and atrial fibrillation (P = 0.27). Despite observed statistical heterogeneity, no significant publication bias was detected.
Investigators concluded the short-acting beta-blocker administration did not reduce the short-term mortality in patients with sepsis and persistent tachycardia, future studies should include comprehensive hemodynamic data to assess cardiac function before and during treatment.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-05174-w
