Effect of oral β-blocker on short and long-term mortality in patients with acute respiratory failure: results from the BASEL-II-ICU study.
Effect of oral β-blocker on short and long-term mortality in patients with acute respiratory failure: results from the BASEL-II-ICU study.
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DOI：
10.1186/cc9317
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发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Mueller C
中科院分区：
文献类型：
--
作者：
Noveanu M;Breidthardt T;Reichlin T;Gayat E;Potocki M;Pargger H;Heise A;Meissner J;Twerenbold R;Muravitskaya N;Mebazaa A;Mueller C
急性呼吸衰竭（ARF）占重症监护病房（ICU）入院人数的三分之一，并与不良结局相关。急性肾功能衰竭患者的短期和长期预后的预测因素尚不明确。本分析的目的是确定院内和一年死亡率的预测因素，并评估BASEL-II-ICU研究中ARF的ICU患者口服β受体阻滞剂的效果。巴塞尔II-ICU研究是一项前瞻性、多中心、随机、单盲、对照试验，纳入314例（平均年龄70（62 - 79）岁）ARF ICU患者，评价B型利钠肽（BNP）指导的管理策略对短期结局的影响。住院死亡率为16%（51例患者），1年死亡率为41%（128例患者）。多变量分析评估，入院时口服β受体阻滞剂与住院（HR 0.33（0.14 - 0.74）P = 0.007）和1年死亡率（HR 0.29（0.16 - 0.51）P = 0.0003）的风险降低相关。Kaplan-Meier分析证实了ARF患者在入院时口服β受体阻滞剂的死亡率较低，并进一步表明，在心源性或非心源性ARF患者的两个亚组中，入院时口服β受体阻滞剂的有益作用是真实的。Kaplan-Meier分析还表明，出院前口服β受体阻滞剂对一年死亡率有显著的额外有益作用。已确立的β受体阻滞剂治疗似乎与ICU急性呼吸衰竭患者死亡率降低相关。停止既定的治疗似乎是危险的。出院前开始治疗似乎有益。无论呼吸衰竭的心源性或非心源性病因如何，均观察到该结果。clinicalTrials.gov标识符：NCT 00130559
Acute respiratory failure (ARF) is responsible for about one-third of intensive care unit (ICU) admissions and is associated with adverse outcomes. Predictors of short- and long-term outcomes in unselected ICU-patients with ARF are ill-defined. The purpose of this analysis was to determine predictors of in-hospital and one-year mortality and assess the effects of oral beta-blockers in unselected ICU patients with ARF included in the BASEL-II-ICU study. The BASEL II-ICU study was a prospective, multicenter, randomized, single-blinded, controlled trial of 314 (mean age 70 (62 to 79) years) ICU patients with ARF evaluating impact of a B-type natriuretic peptide- (BNP) guided management strategy on short-term outcomes. In-hospital mortality was 16% (51 patients) and one-year mortality 41% (128 patients). Multivariate analysis assessed that oral beta-blockers at admission were associated with a lower risk of both in-hospital (HR 0.33 (0.14 to 0.74) P = 0.007) and one-year mortality (HR 0.29 (0.16 to 0.51) P = 0.0003). Kaplan-Meier analysis confirmed the lower mortality in ARF patients when admitted with oral beta-blocker and further shows that the beneficial effect of oral beta-blockers at admission holds true in the two subgroups of patients with ARF related to cardiac or non-cardiac causes. Kaplan-Meier analysis also shows that administration of oral beta-blockers before hospital discharge gives striking additional beneficial effects on one-year mortality. Established beta-blocker therapy appears to be associated with a reduced mortality in ICU patients with acute respiratory failure. Cessation of established therapy appears to be hazardous. Initiation of therapy prior to discharge appears to confer benefit. This finding was seen regardless of the cardiac or non-cardiac etiology of respiratory failure. clinicalTrials.gov Identifier: NCT00130559
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