Supplementary file 1_Impact of early β-blocker use on the incidence of sepsis and clinical outcomes following cardiac surgery: a retrospective cohort study.docx

BackgroundSepsis after cardiac surgery represents a severe perioperative complication with high incidence and mortality rates. While the cardioprotective benefits of β-blocker following cardiac surgery are widely recognized, their impact on sepsis development remains unclear. This study aims to investigate the association between early postoperative β-blocker use and the incidence of sepsis, as well as clinical outcomes, in patients undergoing cardiac surgery.
MethodsThe analysis incorporated data from the MIMIC-IV database, with confounding factors addressed through propensity score matching (PSM), inverse probability of treatment weighting (IPTW), and overlap weighting (OW). Logistic regression models assessed the risk of sepsis and in-hospital mortality, while Cox proportional hazards models evaluated 28-day and 1-year mortality. Kaplan-Meier survival curves and log-rank tests compared survival between groups. Sensitivity analyses using Fine-Gray competing risk models and cumulative incidence functions were performed. Subgroup analyses explored heterogeneity of treatment effects, and metoprolol was further stratified by dose to assess dose-response relationships.
ResultsA total of 3,154 patients treated with β-blocker and 5,220 controls were included. Early β-blocker use was associated with a reduced risk of sepsis and lower in-hospital mortality across all methods. For 28-day and 1-year mortality, β-blocker use showed a trend toward risk reduction. Competing risk analyses demonstrated lower cumulative incidence of sepsis in the β-blocker group. Subgroup and dose-response analyses indicated that both low and high doses of metoprolol were associated with reduced postoperative sepsis risk and mortality outcomes.
ConclusionEarly use of β-blocker after cardiac surgery was associated with a lower incidence of sepsis, with potential benefits observed in both short-term and long-term prognosis. These findings provide valuable evidence for optimizing perioperative drug management strategies.

背景 心脏手术后脓毒症（Sepsis）是一类严重的围手术期并发症，具有较高的发病率与死亡率。尽管心脏手术后使用β受体阻滞剂（β-blocker）的心脏保护获益已得到广泛认可，但其对脓毒症发生的影响仍不明确。本研究旨在探讨心脏手术患者术后早期使用β受体阻滞剂与脓毒症发病率及临床结局之间的关联。
方法 本分析纳入了MIMIC-IV数据库的数据，通过倾向得分匹配（propensity score matching, PSM）、治疗加权逆概率（inverse probability of treatment weighting, IPTW）以及重叠加权（overlap weighting, OW）来控制混杂因素。采用logistic回归模型评估脓毒症及院内死亡的风险，使用Cox比例风险模型分析28天及1年死亡率。通过Kaplan-Meier生存曲线与对数秩检验（log-rank tests）比较两组患者的生存情况。此外，采用Fine-Gray竞争风险模型与累积发生率函数进行敏感性分析，通过亚组分析探索治疗效应的异质性，并对美托洛尔（metoprolol）进行剂量分层以评估剂量-反应关系。
结果 本研究共纳入接受β受体阻滞剂治疗的患者3154例，对照组患者5220例。所有分析方法均显示，术后早期使用β受体阻滞剂可降低脓毒症风险与院内死亡率。在28天及1年死亡率方面，β受体阻滞剂使用呈现出风险降低的趋势。竞争风险分析表明，β受体阻滞剂组患者的脓毒症累积发生率更低。亚组分析与剂量反应分析显示，无论低剂量还是高剂量美托洛尔，均与术后脓毒症风险降低及死亡率改善相关。
结论 心脏手术后早期使用β受体阻滞剂与脓毒症发病率降低相关，在短期与长期预后中均展现出潜在获益。本研究结果为优化围手术期药物管理策略提供了有价值的证据。