Impact of early β-blocker use on the incidence of sepsis and clinical outcomes following cardiac surgery: A retrospective cohort study

Chen Yin¹Chengjian Guan¹Qianli Ma¹Shaotong Zhang¹Qian Chen²Bing Xiao^1*

• ¹Second Hospital of Hebei Medical University, Shijiazhuang, China
• ²Hebei Medical University, Shijiazhuang, Hebei Province, China

Background: Sepsis 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.The 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 inhospital 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. Results: A total of 3,154 patients treated with β-blocker and 5,220 controls were included. Early βblocker 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.Early 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.