Association between the early use of beta-blocker and the risk of sepsis-associated acute kidney injury: A retrospective cohort study using the MIMIC-IV database.

BACKGROUND: Sepsis-associated acute kidney injury (SA-AKI) is a common and life-threatening complication in critically ill patients. Studies have shown that the use of beta-blockers improves hemodynamics and the risk of death in patients with sepsis. However, the association between beta-blockers use and the risk of AKI in patients with sepsis remains poorly understood. The present study aimed to evaluate this potential association.

METHOD: Sepsis patients for this retrospective cohort study were extracted from the Medical Information Mart for Intensive Care-IV (MIMIC) database. Propensity score matching (PSM) was used to balance the basic characteristics between beta-blocker users and non-users. Univariate and multivariable logistic regression analysis were employed to evaluate the association between early use of beta-blocker and SA-AKI. Odds ratio (OR) and 95% confidence interval (CI) were estimated as effect measurements.

RESULTS: Totally 4,419 patients with sepsis were enrolled in our study. The follow-up period was from the 24th hour of intensive care unit (ICU) admission to the occurrence of AKI or ICU discharge, with 2,122 (48.02%) cases of developed AKI. After PSM, a lower SA-AKI risk was observed in the early use of the beta-blockers group compared to the non-user group (adjusted OR: 0.80; 95%CI: 0.64-0.99). Similar associations of early use of beta-blockers and SA-AKI were observed in patients younger than 65 years old, male, without comorbidities, and with Simplified Acute Physiology Score II/Charlson comorbidity index scores below the median (all P < 0.05).

CONCLUSION: In ICU patients with sepsis, early use of beta-blockers is associated with a reduced risk of AKI, which may help reduce renal impairment and improve survival. Further studies are needed to verify the underlying mechanisms of beta-blockers in the development of SA-AKI.