Effect of Esmolol on Clinical Outcomes in Critically Ill Patients: Data from the MIMIC-IV Database

Qihong Liang; Lulan Li; Kerong Chen; Sheng An; Zhiya Deng; Jiaxin Li; Shiyu Zhou; Zhongqing Chen; Zhenhua Zeng; Shengli An

doi:10.1177/10742484231185985

Effect of Esmolol on Clinical Outcomes in Critically Ill Patients: Data from the MIMIC-IV Database

J Cardiovasc Pharmacol Ther. 2023 Jan-Dec:28:10742484231185985. doi: 10.1177/10742484231185985.

Authors

Qihong Liang^{1

2}, Lulan Li^{1

3}, Kerong Chen¹, Sheng An¹, Zhiya Deng¹, Jiaxin Li¹, Shiyu Zhou^{1

2}, Zhongqing Chen¹, Zhenhua Zeng^{1

3}, Shengli An²

Affiliations

¹ Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.
² Department of Biostatistics, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, Guangdong, China.
³ Department of Pathophysiology, Guangdong Provincial Key Lab of Shock and Microcirculation, Southern Medical University, Guangzhou, China.

PMID: 37415421
DOI: 10.1177/10742484231185985

Abstract

Background and aims: Esmolol is a common short-acting drug to control ventricular rate. This study aimed to evaluate the association between use of esmolol and mortality in critically ill patients.

Methods: This is a retrospective cohort study from MIMIC-IV database containing adult patients with a heart rate of over 100 beats/min during the intensive care unit (ICU) stay. Multivariable Cox proportional hazard models and logistic regression were used to explore the association between esmolol and mortality and adjust confounders. A 1:1 nearest neighbor propensity score matching (PSM) was performed to minimize potential cofounding bias. The comparison for secondary outcomes was performed at different points of time using an independent t-test.

Results: A total of 30,332 patients were reviewed and identified as critically ill. There was no significant difference in 28-day mortality between two groups before (HR = 0.90, 95% CI = 0.73-1.12, p = 0.343) and after PSM (HR = 0.84, 95% CI = 0.65-1.08, p = 0.167). Similar results were shown in 90-day mortality before (HR = 0.93, 95% CI = 0.75-1.14, p = 0.484) and after PSM (HR = 0.85, 95% CI = 0.67-1.09, p = 0.193). However, esmolol treatment was associated with higher requirement of vasopressor use before (HR = 2.89, 95% CI = 2.18-3.82, p < 0.001) and after PSM (HR = 2.66, 95% CI = 2.06-3.45, p < 0.001). Esmolol treatment statistically reduced diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (all p < 0.001) and increased fluid balance at 24 hours (p < 0.05) but did not significantly lower SBP (p = 0.721). Patients in esmolol group showed no significant difference in lactate levels and daily urine output when compared with those in non-esmolol group when adjusted for confounders (all p > 0.05).

Conclusion: Esmolol treatment was associated with reduced heart rate and lowered DBP and MAP, which may increase vasopressor use and fluid balance at the timepoint of 24 hours in critically ill patients during ICU stay. However, after adjusting for confounders, esmolol treatment was not associated with 28-day and 90-day mortality.

Keywords: MIMIC database; critically ill; esmolol; mortality; vasopressor.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Critical Illness*
Heart Rate
Humans
Intensive Care Units
Retrospective Studies
Vasoconstrictor Agents* / pharmacology

Substances

Vasoconstrictor Agents
esmolol