preadmission beta-blocker use and 30-day mortality among patients in intensive care a cohort study提前进气β受体阻滞剂的使用和30天死亡率在重症监护的病人队列研究.pdfVIP

Christensen et al. Critical Care 2011, 15:R87 /content/15/2/R87 RESEARCH Open Access Preadmission beta-blocker use and 30-day mortality among patients in intensive care: a cohort study 1,2* 1 2 3 1 Steffen Christensen , Martin Berg Johansen , Else Tønnesen , Anders Larsson , Lars Pedersen , Stanley Lemeshow4 and Henrik Toft Sørensen1 Abstract Introduction: 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. Methods: 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. Results: 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