Abstract：
Background and Objectives: Previous studies have suggested that long-term β-blocker therapy before sepsis is associated with reduced mortality. Sepsis-associated coagulopathy (SAC) remains a common complication in patients with sepsis and is associated with increased mortality. Adrenergic pathways are involved in the regulation of the coagulation system. Pre-existing long-term β-blocker therapy may have potentially beneficial effects on SAC and has yet to be well characterized. We aimed to assess the potential association between pre-existing long-term β-blocker therapy and the outcomes of patients with SAC. Materials and Methods: This study retrospectively screened the clinical data of adult patients with SAC admitted to the Intensive Care Unit (ICU) and respiratory ICU between May 2020 and October 2022. Patients with SAC who took any β-blocker for at least one year were considered pre-existing long-term β-blocker therapy. All enrolled patients were followed up for 28 days or until death. Results: Among the 228 SAC patients, 48 received long-term β-blocker therapy before septic episodes. Pre-existing long-term β-blocker therapy was associated with reduced vasopressor requirements and a decreased 28-day mortality (log-rank test: p = 0.041). In particular, long-term β-blocker therapy was related to substantially lower D-dimer levels and a trend of improved activated partial thromboplastin time in patients with SAC during initial ICU admission. Multivariable regression analysis showed that long-term β-blocker therapy was significantly and independently associated with a 28-day mortality among patients with SAC (adjusted odds ratio, 0.55; 95% confidence interval, (0.32-0.94); p = 0.030). Conclusions: Pre-existing long-term β-blocker therapy might be associated with reduced vasopressor requirements and a decreased 28-day mortality among patients with SAC, providing evidence for the protective effect of β-blockers against SAC in managing sepsis.
摘要：
背景和目的：先前的研究表明，脓毒症前的长期β受体阻滞剂治疗可降低死亡率。脓毒症相关凝血病（SAC）仍然是脓毒症患者的常见并发症，并与死亡率增加有关。肾上腺素能途径参与凝血系统的调节。预先存在的长期β受体阻滞剂治疗可能对SAC具有潜在的有益作用，但尚未得到充分表征。我们旨在评估已有的长期β受体阻滞剂治疗与SAC患者预后之间的潜在关联。材料和方法：本研究回顾性筛选了2020年5月至2022年10月期间入住重症监护病房（ICU）和呼吸ICU的SAC成年患者的临床资料。服用任何β受体阻滞剂至少一年的SAC患者被认为是预先存在的长期β受体阻滞剂治疗。所有入选患者均随访28天或直至死亡。结果:228例SAC患者中,48例在脓毒症发作前接受了长期β受体阻滞剂治疗。预先存在的长期β受体阻滞剂治疗与血管加压药需求降低和28天死亡率降低相关(对数秩检验:p=0.041)。特别是,长期β受体阻滞剂治疗与SAC患者在初次入住ICU期间显著降低D-二聚体水平和改善活化部分凝血活酶时间的趋势相关.多变量回归分析显示，在SAC患者中，长期β受体阻滞剂治疗与28天死亡率显著且独立相关(调整后的比值比，0.55；95%置信区间，（0.32-0.94）；p=0.030）。结论：预先存在的长期β受体阻滞剂治疗可能与SAC患者的血管加压药需求减少和28天死亡率降低有关。为β受体阻滞剂对SAC的保护作用提供证据。
