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Association Between Prior Calcium Channel Blocker Use and Mortality in Septic Patients: A Meta-Analysis of Cohort
Xianfei Ding1, Yuqing Cui1, Huoyan Liang1
1General Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Centre for Critical Care Medicine, Zhengzhou, China.
Insights
Prior use of calcium channel blockers (CCBs) is linked to better survival rates in sepsis patients. This finding suggests CCBs may offer protective effects against sepsis mortality.
Area of Science:
- Cardiology
- Critical Care Medicine
- Pharmacology
Background:
- Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.
- Calcium channel blockers (CCBs) are widely used cardiovascular medications.
- The impact of prior CCB use on sepsis outcomes remains incompletely understood.
Purpose of the Study:
- To conduct a comprehensive literature review and synthesize evidence on the association between prior CCB use and mortality in sepsis patients.
- To evaluate the impact of CCB use on both 90-day and short-term mortality outcomes in sepsis and septic shock.
Main Methods:
- Systematic search of MEDLINE, EMBASE, Cochrane CENTRAL, and Web of Science databases up to April 9, 2020.
- Inclusion of five cohort studies with low risk of bias, involving 280,982 patients.
- Meta-analysis using random-effects models to calculate pooled odds ratios (ORs) and 95% confidence intervals (CIs).
Main Results:
- Prior CCB use was associated with significantly lower 90-day mortality in sepsis patients (OR, 0.90; 95% CI, 0.85-0.95).
- Prior CCB use was linked to significantly reduced short-term mortality in septic shock patients (OR, 0.61; 95% CI, 0.38-0.97).
- No significant association was found for short-term mortality in the broader sepsis population (OR, 0.83; 95% CI, 0.66-1.04).
Conclusions:
- This meta-analysis indicates that prior CCB use is associated with improved 90-day survival in sepsis patients.
- Prior CCB use demonstrates a significant association with reduced short-term mortality specifically in patients with septic shock.
- The findings provide preliminary evidence supporting a potential beneficial role of CCBs in sepsis management.
Abstract:
Background: The aim of this study was to comprehensively review the literature and synthesize the evidence concerning the relationship between prior calcium channel blocker (CCB) use and mortality in patients with sepsis. Methods: The Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica database (EMBASE), Cochrane CENTRAL, and Web of Science databases were searched from their inception to April 9, 2020. Cohort studies related to prior calcium channel blocker use in patients with sepsis were analyzed. Pairs of reviewers independently screened the studies, extracted the data, and assessed the risk of bias. The primary outcome of 90-days mortality or secondary outcome of short-term mortality, including 30-days, Intensive Care Unit (ICU), and in-hospital mortality, were analyzed. Heterogeneity among studies was assessed using the I 2 statistic and was considered moderate if I 2 was 50-75% and high if I 2 was ≥75%. Random-effects models were used to calculate the pooled odds ratios (ORs) and 95% confidence intervals (CIs). The quality of the studies was evaluated with the Newcastle-Ottawa Scale (NOS). Sensitivity analyses were performed to examine the robustness of the results. Results: In total, 639 potentially relevant studies were identified, and the full texts of 25 articles were reviewed. Ultimately, five cohort studies involving 280,982 patients were confirmed to have a low risk of bias and were included. Prior CCB use was associated with a significantly lower 90-days mortality in sepsis patients [OR, 0.90 (0.85-0.95); I 2 = 31.9%]. Moreover, prior CCB use was associated with a significantly reduced short-term mortality rate in septic shock patients [OR, 0.61 (0.38-0.97); I 2 = 62.4%] but not in sepsis patients [OR, 0.83 (0.66-1.04); I 2 = 95.4%]. Conclusion: This meta-analysis suggests that prior CCB use is significantly associated with improved 90-days mortality in sepsis patients and short-term mortality in septic shock patients. This study provides preliminary evidence of an association between prior CCB use and mortality in sepsis patients.
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