Efficacy of beta-blockers in the treatment of sepsis
Abstract
This meta-analysis is to systematically evaluate the efficacy and safety of beta-blockers in the treatment of sepsis. A total of 17 articles that met the inclusion criteria were included, and 10,385 cases were obtained. The meta-analysis results showed that patients with sepsis with beta-blocker usage had a significantly lower 28-day mortality. The heart rate decreased over time in patients with sepsis using beta-blocker. Moreover, central venous blood oxygen saturation increased after 24, 48, 72 hours of treatment; lactic acid and cardiac troponin I decreased after 48, 72 hours of treatment; and tumor necrosis factor-α, interleukin-1β levels decreased significantly after 12, 24, 48, 72 hours of treatment (p<0.05). In conclusion, beta-blockers reduce 28-day mortality and heart rate.
Downloads
145
126
References
Balik M, Rulisek J, Leden P, Zakharchenko M, Otahal M, Bartakova H, Korinek J. Concomitant use of beta-1 adrenoreceptor blocker and norepinephrine in patients with septic shock. Wien Klin Wochenschr. 2012; 124: 552-56.
Carre JE, Singer M. Cellular energetic metabolism in sepsis: The need for a systems approach. Biochim Biophys Acta. 2008; 1777: 763-71.
Chandra A, Enkhbaatar P, Nakano Y, Traber LD, Traber DL. Sepsis: Emerging role of nitric oxide and selectins. Clinics (Sao Paulo). 2006; 61: 71-76.
Chen JX, Sun J, Liu YY, Jia BH. Effects of adrenergic beta-1 antagonists on hemodynamics of severe septic patients. Zhonghua Yi Xue Za Zhi. 2013; 93: 1243-46.
Duff S, Connolly C, Buggy DJ. Adrenergic, inflammatory, and immune function in the setting of oncological surgery: Their effects on cancer progression and the role of the anesthetic technique in their modulation. Int Anesthesiol Clin. 2016; 54: 48-57.
Duncan DJ, Yang Z, Hopkins PM, Steele DS, Harrison SM. TNF-alpha and IL-1beta increase Ca2+ leak from the sarcoplasmic reticulum and susceptibility to arrhythmia in rat ventricular myocytes. Cell Calcium. 2010; 47: 378-86.
Gao X, Cao W, Guan Y, Luo Y, Lian F, He N, Wang X, Li P. Protective effect of esmolol on myocardial injury in septic patients. Chin J Crit Care Med. 2015; 35: 678-81.
Gong X, Zhang Z, Zhai X, Zhang R. Effects of esmolo on inflammatory responses and left ventricular function in patients with sepsis. Chin J Crit Care Med. 2013; 33: 879-81.
Gore DC, Wolfe RR. Hemodynamic and metabolic effects of selective beta1 adrenergic blockade during sepsis. Surgery 2006; 139: 686-94.
Gutierrez J, Hossam A, Lazarezcu R, Kay E, Rundek T. Effect of beta blockers on sepsis outcome. Med Sci Monit. 2009; 15: Cr499-503.
Jadad AR, Cook DJ, Browman GP. A guide to interpreting discordant systematic reviews. Cmaj. 1997; 156: 1411-16.
Jaffee W, Hodgins S, McGee WT. Tissue edema, fluid balance, and patient outcomes in severe sepsis: An organ systems review. J Intensive Care Med. 2018; 33: 502-09.
Jansen TC, van Bommel J, Bakker J. Blood lactate monitoring in critically ill patients: A systematic health technology assessment. Crit Care Med. 2009; 37: 2827-39.
Lazzeri C, Bonizzoli M, Cianchi G, Gensini GF, Peris A. Troponin I in the intensive care unit setting: From the heart to the heart. Intern Emerg Med. 2008; 3: 9-16.
Lee YR, Seth MS, Soney D, Dai H. Benefits of beta-blockade in sepsis and septic shock: A systematic review. Clin Drug Investig. 2019; 39: 429-40.
Liang F, Zhang Z, Ye W, Liang W, Cao F. β-Blockers metoprolol protective effect for heart patients with sepsis. Mod Diagn Treat. 2015; 26: 733-35.
Lorigados CB, Soriano FG, Szabo C. Pathomechanisms of myocardial dysfunction in sepsis. Endocr Metab Immune Disord Drug Targets. 2010; 10: 274-84.
Ma C. The effects of esmolol with intravenous pumping on inflammatory response and cardiac function in patients with sepsis. J Community Med. 2014; 12: 47-48.
Macchia A, Romero M, Comignani PD, Mariani J, D'Ettorre A, Prini N, Santopinto M, Tognoni G. Previous prescription of beta-blockers is associated with reduced mortality among patients hospitalized in intensive care units for sepsis. Crit Care Med. 2012; 40: 2768-72.
Morelli A, Ertmer C, Westphal M, Rehberg S, Kampmeier T, Ligges S, Orecchioni A, D'Egidio A, D'Ippoliti F, Raffone C, Venditti M, Guarracino F, Girardis M, Tritapepe L, Pietropaoli P, Mebazaa A, Singer M. Effect of heart rate control with esmolol on hemodynamic and clinical outcomes in patients with septic shock: A randomized clinical trial. JAMA. 2013; 310: 1683-91.
Morelli A, Singer M, Ranieri VM, D'Egidio A, Mascia L, Orecchioni A, Piscioneri F, Guarracino F, Greco E, Peruzzi M, Biondi-Zoccai G, Frati G, Romano SM. Heart rate reduction with esmolol is associated with improved arterial elastance in patients with septic shock: A prospective observational study. Intensive Care Med. 2016; 42: 1528-34.
Muriova K, Malaska J, Otevrel F, Slezak M, Kratochvil M, Sevik P. Myocardial dysfunction in sepsis: Definition and pathogenetic mechanisms. Vnitr Lek. 2010; 56: 220-25.
Ogrodowczyk M, Dettlaff K, Jelinska A. Beta-blockers: Current state of knowledge and perspectives. Mini Rev Med Chem. 2016; 16: 40-54.
Phillips R, Hancock B, Graham J, Bromham N, Jin H, Berendse S. Prevention and management of neutropenic sepsis in patients with cancer: Summary of NICE guidance. BMJ. 2012; 345: e5368.
Schlager O, Gajdosova Kovacicova L, Senn O, Amann-Vesti B, Wilkinson IB, Jacomella V, Husmann M. Beta-blockers and vascular hemodynamics in patients with peripheral arterial disease. J Clin Hypertens (Greenwich). 2016; 18: 1244-49.
Schmittinger CA, Dunser MW, Haller M, Ulmer H, Luckner G, Torgersen C, Jochberger S, Hasibeder WR. Combined milrinone and enteral metoprolol therapy in patients with septic myocardial depression. Crit Care. 2008; 12: R99.
Shang X, Wang K, Xu J, Gong S, Ye Y, Chen K, Lian F, Chen W, Yu R. The effect of esmolol on tissue perfusion and clinical prognosis of patients with severe sepsis: A prospective cohort study. Biomed Res Int. 2016; 2016: 1038034.
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010; 25: 603-05.
Tao Y, Jingyi W, Xiaogan J, Weihua L, Xiaoju J. Effect of esmolol on fluid responsiveness and hemodynamic para-meters in patients with septic shock. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2015; 27: 885-89.
Trzeciak S, Dellinger RP, Chansky ME, Arnold RC, Schorr C, Milcarek B, Hollenberg SM, Parrillo JE. Serum lactate as a predictor of mortality in patients with infection. Intensive Care Med. 2007; 33: 970-77.
Wang HE, Shapiro NI, Griffin R, Safford MM, Judd S, Howard G. Chronic medical conditions and risk of sepsis. PLoS One. 2012; 7: e48307.
Wei F, Dong H, Lu L, Xue H. Protective effect of esmolol on myocardium of systemic sepsis patients. World Latest Med Inf. 2013; 13: 18-19.
Xinqiang L, Weiping H, Miaoyun W, Wenxin Z, Wenqiang J, Shenglong C, Juhao Z, Hongki Z. Esmolol improves clinical outcome and tissue oxygen metabolism in patients with septic shock through controlling heart rate. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2015; 27: 759-63.
Xu L, Yu WK, Lin ZL, Tan SJ, Bai XW, Ding K, Li N. Impact of beta-adrenoceptor blockade on systemic inflammation and coagulation disturbances in rats with acute traumatic coagulopathy. Med Sci Monit. 2015; 21: 468-76.
Yang S, Liu Z, Yang W, Zhang G, Hou B, Liu J, Shi Q. Effects of the beta-blockers on cardiac protection and hemodynamics in patients with septic shock: A prospective study. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2014; 26: 714-17.
Zhi Y, Wang K, Wang L. Interpretation of the section of Chinese herb medicine in Chinese guidelines for management of severe sepsis and septic shock 2014. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2015; 27: 429-34.
Copyright (c) 2021 Peng Jin, Tao Zhao, Yueyue Wei, Fang Zhao
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
