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Purpose <p>The impact of β-blocker therapy on outcomes in critically ill patients with acute kidney injury (AKI) remains uncertain. While theoretical benefits exist, these are often offset by concerns related to hemodynamic instability.</p> Methods <p>This retrospective cohort study employed the multicenter eICU Collaborative Research Database (2014–2015). Adult patients diagnosed with AKI within 48 h of ICU admission were included. Patients initiating β-blocker therapy within 48 h of ICU admission were compared to non-users. The primary outcome was 28-day all-cause mortality. To control for potential confounding, we applied multivariable Cox regression, propensity score matching (PSM, 1:1), and inverse probability of treatment weighting (IPTW). Sensitivity analyses included subgroup evaluations, multiple imputation, competing risk analysis, and calculation of the E-value.</p> Results <p>Among 3,799 eligible patients, 1,291 (34.0%) received β-blockers. Before PSM, unadjusted 28-day in-hospital mortality was significantly lower in the β-blocker group compared to non-users (18.75% vs. 25.52%, <i>p</i> &lt; 0.001). After PSM (1,186 matched pairs), baseline characteristics were well balanced. The survival benefit persisted in the matched cohort (19.06% vs. 25.13%, <i>p</i> &lt; 0.001). In the multivariable Cox model adjusted for all covariates, β-blocker use was associated with a significant reduction in 28-day mortality (HR 0.62; 95% CI 0.53–0.73; <i>p</i> &lt; 0.001). IPTW analysis yielded consistent estimates (ATE HR 0.71; 95% CI 0.65–0.79; <i>p</i> &lt; 0.001), as did PSM analyses (ATT HR 0.67; 95% CI 0.56–0.80; <i>p</i> &lt; 0.001). Subgroup analyses demonstrated consistent protective effects across most subgroups, with significant effect modification observed only for SOFA and GCS scores (both <i>p</i> for interaction &lt; 0.05). The E-value of 2.17 suggested robustness to unmeasured confounding.</p> Conclusion <p>In this large, multicenter observational cohort of critically ill patients with AKI, early β-blocker therapy (initiated within 48 h of ICU admission) was consistently associated with lower 28-day in-hospital mortality across multiple analytical approaches and sensitivity analyses. These findings highlight a need for prospective studies to evaluate the potential causal benefits of β-blockers in this high-risk population.</p>

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Association of β-blocker use with 28 day in-hospital mortality in critically ill patients with acute kidney injury: a propensity score-matched and inverse probability -weighted analysis of the eicu database

  • 期刊论文

  • 发表日期：

    2026年3月19日

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  • Jing Tang,
  • Daiyu Shen,
  • Shenghai Li,
  • Xinzhu Yuan,
  • Yingxia Ma,
  • Bo Hu

摘要

Purpose

The impact of β-blocker therapy on outcomes in critically ill patients with acute kidney injury (AKI) remains uncertain. While theoretical benefits exist, these are often offset by concerns related to hemodynamic instability.

Methods

This retrospective cohort study employed the multicenter eICU Collaborative Research Database (2014–2015). Adult patients diagnosed with AKI within 48 h of ICU admission were included. Patients initiating β-blocker therapy within 48 h of ICU admission were compared to non-users. The primary outcome was 28-day all-cause mortality. To control for potential confounding, we applied multivariable Cox regression, propensity score matching (PSM, 1:1), and inverse probability of treatment weighting (IPTW). Sensitivity analyses included subgroup evaluations, multiple imputation, competing risk analysis, and calculation of the E-value.

Results

Among 3,799 eligible patients, 1,291 (34.0%) received β-blockers. Before PSM, unadjusted 28-day in-hospital mortality was significantly lower in the β-blocker group compared to non-users (18.75% vs. 25.52%, p < 0.001). After PSM (1,186 matched pairs), baseline characteristics were well balanced. The survival benefit persisted in the matched cohort (19.06% vs. 25.13%, p < 0.001). In the multivariable Cox model adjusted for all covariates, β-blocker use was associated with a significant reduction in 28-day mortality (HR 0.62; 95% CI 0.53–0.73; p < 0.001). IPTW analysis yielded consistent estimates (ATE HR 0.71; 95% CI 0.65–0.79; p < 0.001), as did PSM analyses (ATT HR 0.67; 95% CI 0.56–0.80; p < 0.001). Subgroup analyses demonstrated consistent protective effects across most subgroups, with significant effect modification observed only for SOFA and GCS scores (both p for interaction < 0.05). The E-value of 2.17 suggested robustness to unmeasured confounding.

Conclusion

In this large, multicenter observational cohort of critically ill patients with AKI, early β-blocker therapy (initiated within 48 h of ICU admission) was consistently associated with lower 28-day in-hospital mortality across multiple analytical approaches and sensitivity analyses. These findings highlight a need for prospective studies to evaluate the potential causal benefits of β-blockers in this high-risk population.