Treatment with short-acting betablockers in septic patients remains controversial. Two recent large multicenter trials have provided additional evidence on this therapeutic approach. We thus performed a meta-analysis, including the most recent data, to evaluate the potential impacts of treatment with short-acting betablockers on mortality in adult septic patients. The data search included PubMed, Web of Science, ClinicalTrials.gov and the Cochrane Library. A meta-analysis of all eligible peer-reviewed studies was performed in accordance with the PRISMA statement. Only randomized, controlled studies with valid classifications of sepsis and intravenous treatment with short-acting betablockers (landiolol or esmolol) were included. Short-term mortality served as the primary endpoint. Secondary endpoints included effects on short-term mortality regarding patient age and cardiac rhythm. A total of seven studies summarizing 854 patients fulfilled the predefined criteria and were included. Short-term mortality as well as pooled mortality (longest period of data on mortality) was not significantly impacted by treatment with short-acting betablockers when compared to the reference treatment (Risk difference, − 0.10 [95% CI, − 0.22 to 0.02]; p = 0.11; p for Cochran’s Q test = 0.001; I2 = 73%). No difference was seen when comparing patients aged < 65 versus ≥ 65 years (p = 0.11) or sinus tachycardia with atrial fibrillation (p = 0.27). Despite statistical heterogeneity, no significant publication bias was observed. Administration of short-acting betablockers did not reduce short-term mortality in septic patients with persistent tachycardia. Future studies should also provide extensive hemodynamic data to enable characterization of cardiac function before and during treatment.

中文翻译：

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接受短效 β 受体阻滞剂治疗的脓毒症患者的死亡率：随机对照试验的综合荟萃分析


脓毒症患者使用短效 β 受体阻滞剂治疗仍存在争议。最近的两项大型多中心试验为这种治疗方法提供了更多证据。因此，我们进行了一项荟萃分析，包括最新数据，以评估短效 β 受体阻滞剂治疗对成年脓毒症患者死亡率的潜在影响。数据检索包括 PubMed、Web of Science、ClinicalTrials.gov 和 Cochrane 图书馆。根据 PRISMA 声明对所有符合条件的同行评审研究进行了荟萃分析。仅纳入了脓毒症有效分类和短效 β 受体阻滞剂（兰地洛尔或艾司洛尔）静脉治疗的随机对照研究。短期死亡率是主要终点。次要终点包括对患者年龄和心律性短期死亡率的影响。共有 7 项研究总结了 854 名患者，符合预定标准并被纳入。与参考治疗相比，短效 β 受体阻滞剂治疗对短期死亡率和合并死亡率（最长的死亡率数据期）没有显著影响（风险差，-0.10 [95% CI，-0.22 至 0.02];p = 0.11;Cochran Q 检验的 p = 0.001;I2 = 73%）。在比较 < 65 岁与 ≥ 65 岁 （p = 0.11） 或窦性心动过速伴心房颤动 （p = 0.27） 的患者时，未见差异。尽管存在统计学异质性，但未观察到显著的发表偏倚。短效 β 受体阻滞剂的给药并未降低持续性心动过速脓毒症患者的短期死亡率。未来的研究还应提供广泛的血流动力学数据，以便能够在治疗前和治疗期间描述心脏功能。