Impact of Beta-Blockers on Pneumonia, Mortality and Functional Outcomes of Patients with Intracerebral Hemorrhage-A Retrospective Multicenter Study

Abstract

Bin Gao,1– 3 Anxin Wang,2,4,5 Xiaoli Zhang,2 Jia Zhang,1– 3 Yi Ju,1 Xingquan Zhao,1– 3,6 Wenjuan Wang1– 3 1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China; 2China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China; 3Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People’s Republic of China; 4Department of Epidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China; 5Department of Clinical Epidemiology and Clinical Trial, Capital Medical University, Beijing, People’s Republic of China; 6Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, People’s Republic of ChinaCorrespondence: Xingquan Zhao, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119. Fanyang Road, Fengtai District, Beijing, 100070, People’s Republic of China, Tel [phone], Email [email protected] Wenjuan Wang, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119. Fanyang Road, Fengtai District, Beijing, 100070, People’s Republic of China, Tel [phone], Email [email protected]: Given the current lack of research on the impact of beta-blockers (BB) on clinical outcomes in patients with intracerebral hemorrhage (ICH). This study aimed to evaluate the effect of BB on pneumonia, functional outcomes, and mortality in adult patients with primary ICH.Patients and Methods: This was a retrospective study of a registry cohort of patients with ICH from 13 stroke centers in Beijing, China. Patients aged 18 years or older with first-time primary ICH admitted within 72 h after onset were included. Main exclusion criteria including previous ICH, previous mRS≥ 3, primary intraventricular hemorrhage, missing of baseline data or lost of follow-up. BB group was defined as any use of beta-blockers pre-existing or initiated after onset of ICH, those without any use of beta-blockers were defined as non-BB group. The clinical outcomes were in-hospital pneumonia, mortality and functional outcome (favorable outcome defined as a modified Rankin Score of 0– 3) at 90 d.Results: The study included 947 patients (657 males [69.38%]; mean [standard deviation] age, 57.67 [13.68] years). Two hundred and thirty of 809 patients (28.43%) in the non-BB group and 64 of 138 patients in the BB group were diagnosed with pneumonia (46.38%). Multivariate analysis confirmed that patients in the BB group were likely to have an increased risk of pneumonia after adjusting for confounders (odds ratio [OR], 1.806; 95% confidence interval [CI]:1.139– 2.862; P=0.0119). No statistical difference was observed in the proportion of favorable outcome (P=0.9289) or mortality (P=0.2120) at 90 d between the two groups.Conclusion: The results of this cohort study suggest that any use of BB is associated with an increased risk of pneumonia post-ICH. Randomized clinical trials are needed to evaluate the effects of non-selective BB on the prevention of pneumonia post-ICH.Keywords: beta-blockers, intracerebral hemorrhage, pneumonia, outcome, mortality

Keywords

• beta-blockers
• intracerebral hemorrhage
• pneumonia
• outcome
• mortality