Association of carvedilol with mortality in critically ill patients with sepsis: a retrospective propensity score-matched cohort study

Objective To evaluate the association between carvedilol use and mortality in patients with sepsis. Methods All adult critically ill patients with sepsis were retrospectively identified from the MIMIC-IV database. Patients who received carvedilol between sepsis diagnosis and Intensive Care Unit(ICU) discharge were designated as the intervention group and were matched 1:1 with non-users using propensity score matching. The primary outcomes were 28-day and 365-day all-cause mortality, and the secondary outcome was in-hospital mortality. Kaplan–Meier survival curves and Cox proportional hazards regression models were used to examine the association between carvedilol and outcomes. Subgroup analyses and sensitivity analyses including time-dependent Cox regression were conducted to test robustness. Results A total of 33,453 patients were included, of whom 1,084 received carvedilol. After propensity score matching, 1,082 pairs were successfully matched. Kaplan–Meier survival curves showed significant differences in survival probabilities between the two groups. After adjusting for confounders using multivariate Cox regression, the hazard ratios (95% confidence intervals) for carvedilol use on 28-day and 365-day all-cause mortality were 0.53 (0.43–0.66) and 0.66 (0.57–0.76), respectively. Furthermore, carvedilol use was associated with lower in-hospital mortality (OR = 0.49, 95% CI: 0.37–0.64; P < 0.001). Subgroup and sensitivity analyses supported the robustness of the findings. Conclusion Carvedilol use during the period from sepsis diagnosis to ICU discharge was associated with reduced mortality in critically ill patients with sepsis. However, prospective studies are warranted to further guide the use of carvedilol in this population.