A study in Crit Care Med suggests sepsis patients that are on β-blockers might have a survival advantage over patients that are not on β-blockers. Despite β-blocked patients having more prior cardiac disease, hospitalisations and cardiac risk factors.
The hypothesis that β-blockers might have protective effects in sepsis is not entirely new. At least one clinical trial is underway to explore how beta-blockers influence sepsis.
The theory is sound. Early stage sepsis results in a cathecholaminergic overdrive that could result in myocardial injury or dysfunction. Septic patients who get cardiac dysfunction or injury have a two- to fourfold increase in mortality.
Another possible mechanism is how that same cathecholamine storm stimulate excess cytokine production. By putting a β-blocker lid on that cathecholamine storm perhaps we could put a lid the cytokine storm that then results in inflammation, SIRS and multi-organ failure.
Retrospective study of hospital records, databases and ambulance documentation. Between 2003 and 2008 the authors identified a population of 9465 patients diagnosed with sepsis. 1061 (11,4%) patients were on β-blockers on admission while 8404 (88,8%) remained unexposed to β-blockers.
For obvious reasons the patients on β-blockers had a higher prevalence of risk factors, cardiac disease and hospitalisations than the β-blocker-naive group.
Despite that, the patients who were on β-blockers had a lower mortality.
Patients previously prescribed β-blockers had a mortality of 17,7% while the non-exposed control groups 28 day mortality was 22,1%.
This study, much like this blog by the way, comes with more limitations and disclaimers than the swiss navy. Still, chronic β-blocker prescription may result in increased survival in patients with sepsis.
This could happen through attenuation of the early catecholamine surge. The β-blockers protect the heart from overload and injury. A more intriguing explanation is how β-blockers modulate the inflammatory response that is central to sepsis pathogenesis.
Should the cathecholamine storm be modulated as early as possible? Even in the emergency room or prehospitally? Administering β-blockers to a potentially really, really sick patient sounds terribly counterintuitive, but who knows?
Study lives here:
Previous prescription of β-blockers is associated with reduced mortality among patients hospitalized in intensive care units for sepsis*. Macchia A, Romero M, Comignani PD, Mariani J, D’Ettorre A, Prini N, Santopinto M, Tognoni G. Crit Care Med. 2012 Oct;40(10):2768-72.