Preadmission beta-blocker use and 30-day mortality among patients in intensive care: a cohort study.

Crit Care. 2011 Mar 7;15(2):R87

Authors: Christensen S, Johansen MB, Tonnesen E, Larsson A, Pedersen L, Lemeshow S, Sorensen HT

ABSTRACT: INTRODUCTION: Beta-blockers have cardioprotective, metabolic and immunomodulating effects that may be beneficial to patients in intensive care. We examined the association between preadmission beta-blocker use and 30-day mortality following intensive care. METHODS: We identified 8,087 patients over age 45 admitted to one of three multidisciplinary intensive care units (ICUs) between 1999 and 2005. Data on use of beta-blockers and medications, diagnosis, comorbidities, surgery, markers of socioeconomic status, laboratory tests upon ICU admission, and complete follow-up for mortality were obtained from medical databases. We computed probability of death within 30-days following ICU admission for beta-blocker users and non-users, and the odds ratio (OR) of death as a measure of relative risk using conditional logistic regression and also did a propensity score-matched analysis. RESULTS: Inclusion of all 8,087 ICU patients in a logistic regression analysis yielded an adjusted OR of 0.82 (95% CI: 0.71 to 0.94) for beta-blocker users compared with non-users. In the propensity score-matched analysis we matched all 1,556 beta-blocker users (19.2% of the entire cohort) with 1,556 non-users; the 30-day mortality was 25.7% among beta-blocker users and 31.4% among non-users [OR 0.74 (95% CI: 0.63 to 0.87)]. The OR was 0.69 (95% CI: 0.54 to 0.88) for surgical ICU patients and 0.71 (95% CI: 0.51 to 0.98) for medical ICU patients. The OR was 0.99 (95% CI: 0.67 to 1.47) among users of non-selective beta-blockers, and 0.70 (95% CI: 0.58 to 0.83) among users of cardioselective beta-blockers. CONCLUSIONS: Preadmission beta-blocker use is associated with reduced mortality following ICU admission.

PMID: 21385356 [PubMed - as supplied by publisher]

Activated protein C in septic shock: a propensity-matched analysis.

Crit Care. 2011 Mar 8;15(2):R89

Authors: Sadaka F, O'Brien J, Migneron M, Stortz J, Vanston A, Taylor RW

ABSTRACT: INTRODUCTION: The use of human recombinant activated protein C (rhAPC) for the treatment of severe sepsis remains controversial despite multiple reported trials. The efficacy of rhAPC remains a matter of dispute. We hypothesized that patients with septic shock who were treated with rhAPC had an improved in-hospital mortality compared to patients with septic shock with similar acuity who did not receive rhAPC. METHODS: This retrospective cohort study was completed at a large University-affiliated hospital. All patients with septic shock admitted to a 50-bed ICU between July 2003 and February 2009 were included. Patients were treated according to sepsis management guidelines. RESULTS: A total of 563 septic shock patients were included (110 received rhAPC and 453 did not). Treated and untreated groups were matched in patient characteristics, comorbidities, and physiologic variables in a 1:1 propensity-matched analysis (108 received rhAPC, 108 did not). Mean Acute Physiology And Chronic Health Evaluation II (APACHE II) scores were 24.5 for the matched treated and 23.9 for the matched untreated group (P=0.54). Receipt of rhAPC was associated with reduced in-hospital mortality (35.2% vs. 53.8%, P=0.005), similar mean days on vasopressors (2 vs. 2, P=0.90), similar mean days on mechanical ventilation (9 vs. 8.7, P=0.80), similar mean length of ICU stay in days (11.0 vs. 11.3, P=0.90), and similar mean length of hospital stay in days (19.5 vs 27, P=0.11). No patients in either group had intracranial bleeding; differences in gastrointestinal bleeding and transfusion requirements were not statistically significant. CONCLUSIONS: Patients in our institution with septic shock who were treated with rhAPC had a reduced in-hospital mortality compared with patients with septic shock with similar acuity who were not treated with rhAPC. In addition, time on mechanical ventilation, time on vasopressors, lengths of stay and bleeding complications did not differ between the groups.

PMID: 21385410 [PubMed - as supplied by publisher]