Landiolol and Organ Failure in Patients With Septic Shock: The STRESS-L Randomized Clinical Trial

Area of Science:

• Critical Care Medicine
• Pharmacology
• Cardiovascular Physiology

Background:

• Septic shock involves adrenergic stress impacting multiple organ systems.
• Beta-blockade may mitigate catecholamine effects and reduce mortality in septic shock.
• Tachycardia is a common complication in septic shock requiring vasopressor support.

Purpose of the Study:

• To evaluate the efficacy and safety of landiolol in septic shock patients with tachycardia.
• To determine if landiolol reduces organ failure (SOFA score) in patients requiring prolonged vasopressor therapy.

Main Methods:

• Open-label, multicenter, randomized trial of 126 adult septic shock patients with tachycardia.
• Participants received either standard care or landiolol infusion alongside norepinephrine.
• Primary outcome: mean Sequential Organ Failure Assessment (SOFA) score over 14 days.

Main Results:

• The trial was terminated early due to a signal of possible harm and lack of demonstrated benefit.
• Landiolol did not significantly reduce the mean SOFA score compared to standard care (MD, 0.75; P=.24).
• No significant difference in 28-day or 90-day mortality between groups; similar adverse event rates.

Conclusions:

• Landiolol infusion did not improve organ failure in septic shock patients with tachycardia treated with norepinephrine.
• The findings do not support the use of landiolol for managing tachycardia in this patient population.
• Further research is needed to clarify the role of beta-blockers in septic shock management.