ArticleJournal of thoracic disease2026
Risk and mediation analysis of early β-blocker use on survival outcomes in sepsis patients and new-onset atrial fibrillation: an analysis of the MIMIC-IV database.
Article in Journal of thoracic disease, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: New-onset atrial fibrillation (NOAF) frequently occurs in patients with sepsis and is associated with poor prognosis, but evidence regarding the prognostic impact and potential mechanisms of early β-blocker therapy remains limited. This study explores the relation of early β-blocker administration to adverse survival outcomes in sepsis patients complicated by NOAF and the mediating role of the Sequential Organ Failure Assessment (SOFA) score. Methods: This retrospective cohort study included 2008-2022 Medical Information Mart for Intensive Care IV (MIMIC-IV) patients satisfying the Sepsis-3 criteria and developing NOAF after the first intensive care unit (ICU) entry. Exposure was β-blocker use within 24 hours after entering the ICU. The primary and secondary outcomes were 30- and 90-day all-cause mortality (ACM). Baseline characteristics were balanced via propensity score matching (PSM) (1:1). Kaplan-Meier (KM) survival analysis and Cox proportional hazards models were utilized to assess associations. The mediating effect of the SOFA score was quantified via mediation analysis. Results: After PSM, 177 patients receiving early β-blocker therapy were matched with 177 patients who did not, achieving adequate covariate balance. Cox proportional hazards modeling demonstrated a significant association between early β-blocker use and a lower 30-day ACM risk [hazard ratio (HR) =0.663;95% confidence interval (CI): 0.468-0.939; P=0.02], with a similar trend for 90-day ACM. Subgroup and sensitivity analyses confirmed the robustness of the results. Mediation analysis indicated that the SOFA score significantly mediated the association with 30-day ACM, accounting for 34.228% of the total effect. Conclusions: Among critically ill sepsis patients complicated by NOAF, early β-blocker administration was associated with reduced 30- and 90-day ACM, partially mediated by a reduction in SOFA scores. These findings warrant further verification in future research.
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