Preadmission beta-blocker use and 30-day mortality among patients in intensive care: a cohort study
1 Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Olof Palmes Alle, Aarhus N 8240, Denmark
2 Department of Anaesthesiology and Intensive Care, Aarhus Hospital, Aarhus University Hospital, Nørrebrogade, Aarhus C 8000, Denmark
3 Department of Anaesthesiology and Intensive Care Medicine, Uppsala University Hospital, Uppsala S-751 85, Sweden
4 Division of Biostatistics, College of Public Health, Ohio State University, 10th Avenue, M-116 Starling Loving Hall, Columbus, OH 43210, USA
Critical Care 2011, 15:R87 doi:10.1186/cc10085Published: 7 March 2011
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.
We identified 8,087 patients over age 45 admitted to one of three multidisciplinary intensive care units (ICUs) between 1999 and 2005. Data on the 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.
Inclusion of all 8,087 ICU patients in a logistic regression analysis yielded an adjusted OR of 0.82 (95% confidence interval (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.
Preadmission beta-blocker use is associated with reduced mortality following ICU admission.