Association of Long-Term Oral β-Blocker Use With Cardiac Troponin I and B-Type Natriuretic Peptide in Septic
Zheng Yang1, Aihua Jiang1, Yunlong Zhu1
1Emergency Department Tongde Hospital of Zhejiang Province Affiliated to Zhejiang Chinese Medical University Hangzhou China.
Insights
Chronic oral beta-blocker use in sepsis patients with myocardial injury correlates with lower cardiac biomarkers like troponin I and BNP. However, this did not improve short-term survival rates.
Area of Science:
- Cardiology
- Critical Care Medicine
- Pharmacology
Background:
- Septic myocardial injury, marked by elevated cardiac troponin I (cTnI) and B-type natriuretic peptide (BNP), is linked to higher sepsis mortality.
- Understanding factors influencing septic myocardial injury is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the association between chronic oral beta-blocker use and cardiac biomarker levels in sepsis patients.
- To evaluate the impact of beta-blocker use on short-term outcomes, including mortality and ICU length of stay.
Main Methods:
- A retrospective cohort study included 289 patients with septic myocardial injury admitted to the ICU/EICU.
- Patients were categorized into chronic beta-blocker users (n=102) and non-users (n=187).
- Linear regression models analyzed associations between beta-blocker use and cTnI/BNP levels, adjusting for covariates; 28-day mortality and ICU stay were secondary outcomes.
Main Results:
- Chronic beta-blocker use was independently linked to significantly lower serum cTnI and BNP levels.
- No significant differences were found in 28-day mortality or ICU length of stay between the groups.
- Subgroup analyses suggested greater biomarker reductions in younger patients (<60 years) and those with pulmonary infections, though with limited sample sizes.
Conclusions:
- Long-term beta-blocker therapy is associated with reduced cardiac injury biomarkers in septic myocardial injury.
- Biochemical improvements did not translate to short-term survival benefits in this cohort.
- Prospective trials are necessary to ascertain if myocardial protection from beta-blockers confers clinical benefits.
Background And Aims:
Septic myocardial injury, characterized by elevated levels of cardiac troponin I (cTnI) and B-type natriuretic peptide (BNP), is associated with increased mortality in sepsis. This study aimed to evaluate whether chronic oral β-blocker use is associated with reduced cardiac biomarker levels and improved short-term outcomes.
Methods:
We conducted a retrospective cohort study of 289 patients diagnosed with septic myocardial injury admitted to the ICU/EICU from January 2015 to June 2020. Patients were stratified into chronic β-blocker users (n = 102) and non-users (n = 187). Associations between β-blocker use and serum cTnI and BNP levels were analyzed using univariate and multivariate linear regression, adjusting for age, severity scores (SOFA, APACHE II), infection site, and vasopressor use. Secondary outcomes included 28-day mortality and ICU length of stay. Subgroup analyses were performed by age and infection site.
Results:
Chronic β-blocker use was independently associated with significantly lower serum levels of cTnI (0.19 vs. 0.29 μg/L; β = -0.07; 95% CI: -0.12 to -0.02; p < 0.001) and BNP (627 vs. 690 ng/L; β = -36.6; 95% CI: -69.6 to -3.5; p = 0.03). However, no significant differences were observed in 28-day mortality or ICU length of stay. Subgroup analysis revealed greater biomarker reductions in patients under 60 years old and those with pulmonary infections, though sample sizes were limited.
Conclusion:
Long-term β-blocker therapy is associated with lower levels of cardiac injury biomarkers in patients with septic myocardial injury. Subgroup analyses revealed greater reductions in younger patients and those with pulmonary infections, though these findings are exploratory. However, these biochemical improvements did not translate into short-term survival benefits. Prospective trials are needed to determine whether myocardial protection translates into clinical benefit.
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