Intensive & critical care nursing · 2025
Effect of ultrashort-acting β-blocker on the mortality of patients with sepsis or septic shock: A systematic review and trial sequential meta-analysis of randomized controlled trials.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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Huang Po-Yu, Liu Ting-Hui, Wu Jheng-Yan, Tsai Ya-Wen, Hsu Wan-Hsuan, Chuang Min-Hsiang, Tang Hung-Jen, Lai Chih-Cheng
Аннотация
BACKGROUND: Adrenergic responses, particularly tachycardia, play a role in sepsis-related complications. Ultrashort-acting β-blockers have been evaluated in randomized controlled trials (RCTs) for their impact on sepsis outcomes, but conflicting results have been reported. This systematic review and meta-analysis aim to provide an updated perspective on the impact of ultrashort-acting β-blockers on the clinical outcomes of sepsis.
METHODS: A comprehensive search of PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, and ClinicalTrials.gov was conducted from inception to January 12, 2024. RCTs investigating the clinical effects and safety of ultrashort-acting β-blockers in sepsis or septic shock were included. Meta-analyses were performed using random-effects models, and trial sequential analysis (TSA) was conducted to evaluate the reliability of cumulative evidence. The primary outcome was 28-day mortality rate.
RESULTS: A total of 2253 patients involved in 27 RCTs were included. Ultrashort-acting β-blockers significantly reduced the 28-day mortality rate (31.6% versus 48.4%; risk ratio [RR] 0.66; 95% CI 0.56-0.78). TSA provided robust evidence for the 28-day and in-hospital mortality benefit. The survival benefit remains evident in subgroups of patients with septic tachycardia (RR, 0.66; 95% CI, 0.47-0.93), septic cardiomyopathy (RR, 0.61; 95% CI, 0.44-0.83), Chinese populations (RR, 0.64; 95% CI, 0.54-0.76), and those treated with esmolol (RR, 0.64; 95% CI, 0.56-0.73). For patients with septic shock, only those with tachycardia demonstrated a statistically significant difference in mortality rates (RR, 0.70; 95% CI, 0.55-0.88).
CONCLUSIONS: Adjuvant ultrashort-acting β-blocker therapy demonstrated potential benefits in improving survival for patients with sepsis or septic shock.
IMPLICATIONS FOR CLINICAL PRACTICE: This study highlights the potential benefits of adjuvant ultrashort-acting β-blocker therapy for the treatment of sepsis or septic shock in terms of enhanced survival and other clinical advantages, including reduced heart rate and cardiovascular biomarkers. Furthermore, such therapy did not appear to impair cardiac function and hemodynamic stability.
METHODS: A comprehensive search of PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, and ClinicalTrials.gov was conducted from inception to January 12, 2024. RCTs investigating the clinical effects and safety of ultrashort-acting β-blockers in sepsis or septic shock were included. Meta-analyses were performed using random-effects models, and trial sequential analysis (TSA) was conducted to evaluate the reliability of cumulative evidence. The primary outcome was 28-day mortality rate.
RESULTS: A total of 2253 patients involved in 27 RCTs were included. Ultrashort-acting β-blockers significantly reduced the 28-day mortality rate (31.6% versus 48.4%; risk ratio [RR] 0.66; 95% CI 0.56-0.78). TSA provided robust evidence for the 28-day and in-hospital mortality benefit. The survival benefit remains evident in subgroups of patients with septic tachycardia (RR, 0.66; 95% CI, 0.47-0.93), septic cardiomyopathy (RR, 0.61; 95% CI, 0.44-0.83), Chinese populations (RR, 0.64; 95% CI, 0.54-0.76), and those treated with esmolol (RR, 0.64; 95% CI, 0.56-0.73). For patients with septic shock, only those with tachycardia demonstrated a statistically significant difference in mortality rates (RR, 0.70; 95% CI, 0.55-0.88).
CONCLUSIONS: Adjuvant ultrashort-acting β-blocker therapy demonstrated potential benefits in improving survival for patients with sepsis or septic shock.
IMPLICATIONS FOR CLINICAL PRACTICE: This study highlights the potential benefits of adjuvant ultrashort-acting β-blocker therapy for the treatment of sepsis or septic shock in terms of enhanced survival and other clinical advantages, including reduced heart rate and cardiovascular biomarkers. Furthermore, such therapy did not appear to impair cardiac function and hemodynamic stability.