Intravenous beta-blockers versus amiodarone on in-hospital mortality and safety profile in adult septic patients

Guoge Huang; Haizhong Li; Feier Song; Chunmei Zhang; Mengling Jian; Chunyang Huang; Yingqin Zhang; Bei Hu; Wenqiang Jiang

doi:10.1016/j.medine.2025.502143

Intravenous beta-blockers versus amiodarone on in-hospital mortality and safety profile in adult septic patients

Med Intensiva (Engl Ed). 2025 Jan 20:502143. doi: 10.1016/j.medine.2025.502143. Online ahead of print.

Authors

Guoge Huang¹, Haizhong Li², Feier Song³, Chunmei Zhang⁴, Mengling Jian⁴, Chunyang Huang⁴, Yingqin Zhang⁵, Bei Hu⁶, Wenqiang Jiang⁷

Affiliations

¹ Emergency Intensive Care Unit, Department of Emergency Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou 510080, Guangdong, China; Department of Emergency Medicine, People's Hospital of Longhua, Shenzhen 518109, China.
² Emergency Intensive Care Unit, Department of Emergency Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou 510080, Guangdong, China; Department of Emergency, Boai Hospital of Zhongshan, No. 6 Chenggui Road, Zhongshan 528403, Guangdong, China.
³ Emergency Intensive Care Unit, Department of Emergency Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou 510080, Guangdong, China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China.
⁴ Emergency Intensive Care Unit, Department of Emergency Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou 510080, Guangdong, China.
⁵ Emergency Intensive Care Unit, Department of Emergency Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou 510080, Guangdong, China; School of Medicine, South China University of Technology, Guangzhou University City, Guangzhou 510006, Guangdong, China.
⁶ Emergency Intensive Care Unit, Department of Emergency Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou 510080, Guangdong, China. Electronic address: [email protected].
⁷ Emergency Intensive Care Unit, Department of Emergency Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou 510080, Guangdong, China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China. Electronic address: [email protected].

PMID: 39837743
DOI: 10.1016/j.medine.2025.502143

Abstract

Objective: In the present study, we aimed to compare in-hospital mortality and safety of intravenous beta-blockers and amiodarone in septic patients with new-onset atrial fibrillation (NOAF). The null hypothesis is that there is no significant difference in in-hospital mortality and safety of Beta-blocker (BBs) and amiodarone in treating NOAF in patients with sepsis.

Design: We conducted a retrospective analysis based on the MIMIC-IV database. Septic patients with NOAF were screened.

Setting: Patients admitted to adult mixed ICU for septic patients with NOAF.

Patients: A total of 34,789 patients were screened of whom 1394 patients were included for the analysis: 286 in the amiodarone group and 1108 in the BBs group.

Interventions: None.

Main variables of interest: Cox proportional hazard model was used to examine the in-hospital mortality, ventilator-free days and duration of atrial fibrillation in patients receiving either amiodarone or intravenous BBs. Propensity score matching was applied to determine any association.

Results: After Propensity Score (PS) matching, a total of 244 patients were included in both the BB and amiodarone groups. In this cohort, BBs was significantly associated with lower in-hospital mortality [adjusted hazard ratio (HR) of 0.70 (95% CI 0,54-0,91; P = 0.008)]. On the other hand, patients who received amiodarone had a shorter duration of atrial fibrillation (54.17 h vs 72.81 h; P = 0.003). There was no significant difference in ventilator-free days between the BB group and the amiodarone group.

Conclusion: In septic patients with NOAF, patients receiving BBs had lower in-hospital mortality than those who received amiodarone. On the other hand, amiodarone group had a shorter duration of atrial fibrillation. There was no significant difference in ventilator-free days between the BB group and the amiodarone group.

Keywords: Amiodarona; Amiodarone; Atrial fibrillation; Beta-blocker; Beta-bloqueador; Fibrilación auricular; Mortalidad; Mortality; Sepsis.