Impact of β-blockers on mortality in sepsis-associated acute kidney injury: a retrospective propensity score-matched analysis

Our study aimed at assessing the impact of β-blocker treatment on the mortality of patients with sepsis-associated acute kidney injury (SA-AKI). Clinical data for patients with SA-AKI were collected from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Baseline characteristics between β-blocker users and non-users were adjusted through propensity score matching (PSM). Kaplan-Meier curves and the Cox proportional hazards model were employed to analyze the relationship between β-blocker use and mortality, with the primary outcome being 30-day mortality. This study included data from 8,620 patients, with 3,159 receiving treatment and 5,461 not. After PSM, 2,896 matched pairs were created. The analysis revealed that 30-day (hazard ratio [HR]: 0.58, 95% CI: 0.52-0.65; <i>p</i> < 0.001), 90-day (HR: 0.55, 95% CI: 0.50-0.61; <i>p</i> < 0.001), and 365-day mortality (HR: 0.59, 95% CI: 0.54-0.64; <i>p</i> < 0.001) were significantly reduced in β-blocker users. Treatment with long-acting β-blockers was linked to notable improvement in 30-day (17.0 <i>vs.</i> 29.2%; <i>p</i> < 0.001), 90-day (24.1 <i>vs.</i> 36.0%; <i>p</i> < 0.001), and 365-day survival (31.9 <i>vs.</i> 45.0%; <i>p</i> < 0.001). In contrast, short-acting β-blockers showed no significant effect on 30-day (33.8 <i>vs.</i> 28.3%; <i>p</i> = 0.08), 90-day (37.5 <i>vs.</i> 34.2%; <i>p</i> = 0.07), or 365-day mortality (46.3 <i>vs.</i> 38.8%; <i>p</i> = 0.14). β-blocker therapy was associated with reduced mortality rates at 30, 90, and 365 days in SA-AKI patients. Long-acting β-blockers have demonstrated significant protective effects, while short-acting β-blockers, like esmolol, failed to improve patient survival in SA-AKI.