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SYSTEMATIC REVIEW article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 11 - 2024 |
doi: 10.3389/fmed.2024.1448573
Association of beta blockers and mortality in adults with septic shock: systematic review and meta-analysis of randomized clinical trial
Provisionally accepted- 1 Faculty of Human Medicine, Antenor Orrego Private University, Trujillo, Peru
- 2 Unidad de Cuidados Intensivos. Hospital Regional Docente de Trujillo, Trujillo, Peru
- 3 Faculty of Medicine, Cesar Vallejo University, Trujillo, Peru
Septic shock still entails significant morbidity and mortality, with the heart being affected due to catecholamine overexpression and direct injury from sepsis. Therefore, the effect of β-blocking the receptors to improve performance is promising when attempting to reverse tachycardia and reduce mortality. Methods: We conducted a comprehensive search across five databases for studies published up to January 28, 2024, using a PICO strategy. Ten studies were identified for quantitative analysis and included in our meta-analysis. Results: Our meta-analysis evaluated 28-day in-hospital mortality risk across nine randomized controlled trials (RCTs) involving a total of 1,121 adults with septic shock. We found an association between β-blocker use and reduced overall mortality (OR 0.57; 95% CI 0.34-0.98; I²: 56%). This effect was significant in the esmolol subgroup (OR 0.47; 95% CI 0.26-0.82; I²: 32%), but not in the landiolol subgroup (OR 0.98; 95% CI 0.0-1284.5; I²: 72%). Additionally, the intervention group shows a significant reduction in HR and lactate levels, as well as an increase in stroke volume index (SVI). Conclusions: In adults with septic shock, β-blockers are associated with a reduction in 28-day in-hospital mortality, a benefit primarily observed with esmolol rather than landiolol. Furthermore, improvements in heart rate (HR) control, lactate levels, and SVI were noted. However, these findings should be interpreted with caution, and further high-quality RCTs comparing different β-blockers are necessary to better elucidate these effects.
Keywords: Adrenergic beta-Antagonists, septic shock, Mortality, Systematic review, Meta-analysis
Received: 13 Jun 2024; Accepted: 26 Aug 2024.
Copyright: © 2024 Vásquez-Tirado, Quispe-Castañeda, Meregildo-Rodríguez, Cuadra-Campos, Segura-Plasencia, Arbayza-Avalos, Guzmán-Aguilar, Zavaleta-Ayala and Alva-Guarniz. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Gustavo A. Vásquez-Tirado, Faculty of Human Medicine, Antenor Orrego Private University, Trujillo, 13008, Peru
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