Survival Benefit Analysis of Beta-Blockers in Patients with Sepsis-induced TnT-positive myocardial injury Across Different Clinical Subtypes of Sepsis: A Retrospective Study Based on the MIMIC-IV Database

OBJECTIVE To explore the survival benefits of beta-blockers in patients with sepsis-induced TnT-positive myocardial injury across different clinical subtypes and to analyze their potential mechanisms of action. METHODS Based on the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, 1102 patients meeting sepsis-induced TnT-positive myocardial injury criteria were included. Unsupervised machine learning methods were used for clinical subtype clustering analysis, and multivariate Cox regression was employed to evaluate the impact of beta-blockers on 28-day and 90-day mortality. The mediating role of inflammatory cytokine interleukin-6 (IL-6) and procalcitonin (PCT) was also analyzed. RESULTS Patients were classified into three subtypes: moderate organ dysfunction sepsis-induced TnT-positive myocardial injury, severe inflammatory high-injury sepsis-induced TnT-positive myocardial injury, mild compensatory stable sepsis-induced TnT-positive myocardial injury. Beta-blocker use was significantly associated with reduced all-cause mortality: in all subtypes, 28-day mortality risk was reduced by 81.3% [hazard ratio (HR)=0.187], 76.6% (HR=0.234), and 65.9% (HR=0.341), respectively, and 90-day mortality risk was reduced by 74.2% (HR=0.258), 65.1% (HR=0.349), and 63.6% (HR=0.364), respectively. Selective beta-1 receptor blockers demonstrated the most optimal effects. The mediating role of IL-6 and PCT was not significant on the 28-day mortality rate in patients receiving beta-blocker. CONCLUSION Beta-blockers can significantly improve short-term and medium-term survival rates in patients with sepsis-induced TnT-positive myocardial injury across all subtypes, particularly selective beta-1 blockers.