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- Ahl, Rebecka, 1987-, et al.
(författare)
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Does beta-blockade reduce the risk of depression in patients with isolated severe extracranial injuries?
- 2017
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Ingår i: World Journal of Surgery. - New York : Springer. - 0364-2313 .- 1432-2323. ; 41:7, s. 1801-1806
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Approximately half of trauma patients develop post-traumatic depression. It is suggested that beta-blockade impairs trauma memory recollection, reducing depressive symptoms. This study investigates the effect of early beta-blockade on depression following severe traumatic injuries in patients without significant brain injury.METHODS: Patients were identified by retrospectively reviewing the trauma registry at an urban university hospital between 2007 and 2011. Severe extracranial injuries were defined as extracranial injuries with Abbreviated Injury Scale score ≥3, intracranial Abbreviated Injury Scale score <3 and an Injury Severity Score ≥16. In-hospital deaths and patients prescribed antidepressant therapy ≤1 year prior to admission were excluded. Patients were stratified into groups based on pre-admission beta-blocker status. The primary outcome was post-traumatic depression, defined as receiving antidepressants ≤1 year following trauma.RESULTS: Five hundred and ninety-six patients met the inclusion criteria with 11.4% prescribed pre-admission beta-blockade. Patients receiving beta-blockers were significantly older (57 ± 18 vs. 42 ± 17 years, p < 0.001) with lower Glasgow Coma Scale score (12 ± 3 vs. 14 ± 2, p < 0.001). The beta-blocked cohort spent significantly longer in hospital (21 ± 20 vs. 15 ± 17 days, p < 0.01) and intensive care (4 ± 7 vs. 3 ± 5 days, p = 0.01). A forward logistic regression model was applied and predicted lack of beta-blockade to be associated with increased risk of depression (OR 2.7, 95% CI 1.1-7.2, p = 0.04). After adjusting for group differences, patients lacking beta-blockers demonstrated an increased risk of depression (AOR 3.3, 95% CI 1.2-8.6, p = 0.02).CONCLUSIONS: Pre-admission beta-blockade is associated with a significantly reduced risk of depression following severe traumatic injury. Further investigation is needed to determine the beneficial effects of beta-blockade in these instances.
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| 2. |
- Ahl, Rebecka, 1987-, et al.
(författare)
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Effects of beta-blocker therapy on mortality after elective colon cancer surgery : a Swedish nationwide cohort study
- 2020
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 10:7
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Colon cancer surgery remains associated with substantial postoperative morbidity and mortality despite advances in surgical techniques and care. The trauma of surgery triggers adrenergic hyperactivation which drives adverse stress responses. We hypothesised that outcome benefits are gained by reducing the effects of hyperadrenergic activity with beta-blocker therapy in patients undergoing colon cancer surgery. This study aims to test this hypothesis.DESIGN: Retrospective cohort study.SETTING AND PARTICIPANTS: This is a nationwide study which includes all adult patients undergoing elective colon cancer surgery in Sweden over 10 years. Patient data were collected from the Swedish Colorectal Cancer Registry. The national drugs registry was used to obtain information about beta-blocker use. Patients were subdivided into exposed and unexposed groups. The association between beta-blockade, short-term and long-term mortality was evaluated using Poisson regression, Kaplan-Meier curves and Cox regression.PRIMARY AND SECONDARY OUTCOMES: Primary outcome of interest was 1-year all-cause mortality. Secondary outcomes included 90-day all-cause and 5-year cancer-specific mortality.RESULTS: The study included 22 337 patients of whom 36.1% were prescribed preoperative beta-blockers. Survival was higher in patients on beta-blockers up to 1 year after surgery despite this group being significantly older and of higher comorbidity. Regression analysis demonstrated significant reductions in 90-day deaths (IRR 0.29, 95% CI 0.24 to 0.35, p<0.001) and a 43% risk reduction in 1-year all-cause mortality (adjusted HR 0.57, 95% CI 0.52 to 0.63, p<0.001) in beta-blocked patients. In addition, cancer-specific mortality up to 5 years after surgery was reduced in beta-blocked patients (adjusted HR 0.80, 95% CI 0.73 to 0.88, p<0.001).CONCLUSION: Preoperative beta-blockade is associated with significant reductions in postoperative short-term and long-term mortality following elective colon cancer surgery. Its potential prophylactic effect warrants further interventional studies to determine whether beta-blockade can be used as a way of improving outcomes for this patient group.
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| 3. |
- Ahl, Rebecka, 1987-
(författare)
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The Association Between Beta-Blockade and Clinical Outcomes in the Context of Surgical and Traumatic Stress
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Traumatic injury and major abdominal surgery are areas in general surgery associated with high rates of morbidity and mortality. The overall colorectal cancer surgery mortality rate is around 4%, with that for emergency surgery more than twice as high as for planned. Surgical morbidity varies between 25% and 45%. Around half of trauma patients develop low mood. In one quarter of patients this becomes permanent. Depression is known to impede physical rehabilitation and recovery. The onset of physiological stress, driven by adrenergic hyperactivity following traumatic and surgical injury is hypothesized to contribute to these adverse outcomes. Interest has therefore been sparked into blocking adrenergic receptor activation.Papers I and II investigated the role of beta-blocker therapy in preventing post-traumatic depression following severe traumatic brain injury (Paper I) and severe extracranial injury (Paper II). The Karolinska University Hospital Trauma Registry was used to identify patients admitted between 2007 and 2011. In Paper I (n = 545), patients on pre-injury beta-blocker therapy were matched to beta-blocker naïve patients with equivalent injury burden. Results revealed that beta-blocked patients exhibited a 60% reduced risk of needing antidepressant therapy within one year of trauma. In Paper II (n = 596), the lack of beta-blocker use before extracranial trauma was linked to a three-fold increase in the risk of antidepressant initiation.Papers III-V explored the role of pre-operative beta-blocker therapy in patients undergoing surgery for colorectal cancer between 2007 and 2016, identified using the nationwide Swedish Colorectal Cancer Registry. Paper III (n = 3,187) identified a 69% reduction in the risk of 30-day mortality in beta-blocked patients. Paper IV (n = 22,337) outlined long-term survival benefits for patients on beta-blocker therapy prior to undergoing elective surgery for colon cancer. Beta-blocked patients showed a risk reduction of 42% for 1-year all-cause mortality and 18% for 5-year cancerspecific mortality. Similarly, patients on beta-blocker therapy who underwent surgery for rectal cancer demonstrated improved survival up to one year after surgery with a risk reduction of 57% and a reduction in anastomotic failure and infectious complications in Paper V (n = 11,966).
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| 4. |
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| 5. |
- Mohseni, Shahin, 1978-, et al.
(författare)
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Preinjury β-blockade is protective in isolated severe traumatic brain injury
- 2014
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Ingår i: Journal of Trauma and Acute Care Surgery. - Philadelphia, USA : Lippincott Williams & Wilkins. - 2163-0755 .- 2163-0763. ; 76:3, s. 804-808
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Tidskriftsartikel (refereegranskat)abstract
- Background: The purpose of this study was to investigate the effect of preinjury β-blockade in patients experiencing isolated severe traumatic brain injury (TBI). We hypothesized that β-blockade before TBI is associated with improved survival.Methods: The trauma registry of an urban academic trauma center was queried to identify patients with an isolated severe TBI between January 2007 and December 2011. Isolated severe TBI was defined as an intracranial injury with an Abbreviated Injury Scale (AIS) score of 3 or greater excluding all extracranial injuries AIS score of 3 or greater. Patient demographics, clinical characteristics on admission, injury profile, Injury Severity Score (ISS), AIS score, in-hospital morbidity, and β-blocker exposure were abstracted for analysis. The primary outcome evaluated was in-hospital mortality stratified by preinjury β-blockade exposure.Results: Overall, a total of 662 patients met the study criteria. Of these, 25% (n = 159) were exposed to β-blockade before their traumatic insult. When comparing the demographics and injury characteristics between the groups, the sole difference was age, with the β-blocked group being older (69 [12] years vs. 63 [13] years, p < 0.001). β-blocked patients had a higher rate of infectious complications (30% vs. 19%, p = 0.04), with no difference in cardiac or pulmonary complications between the cohorts. Patients exposed to β-blockade versus no β-blockade experienced 13% and 22% mortality, respectively (p = 0.01). Stepwise logistic regression predicted the absence of β-blockade exposure as a risk factor for mortality (odds ratio, 2.7; 95% confidence interval, 1.5-4.8; p = 0.002). After adjustment for significant differences between the groups, patients not exposed to β-blockade experienced twofold increased risk of mortality (adjusted odds ratio, 2.2; 95% confidence interval, 1.3-3.7; p = 0.004).Conclusion: Preinjury β-blockade improves survival following isolated severe TBI. The role of prophylactic β-blockade and the timing of initiation of such therapy after TBI warrant further investigations.Level of evidence: Therapeutic study, level III; prognostic study, level II.
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| 6. |
- Mohseni, Shahin, 1978-, et al.
(författare)
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The Effect of beta-blockade on Survival After Isolated Severe Traumatic Brain Injury
- 2015
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Ingår i: World Journal of Surgery. - : Springer Science and Business Media LLC. - 0364-2313 .- 1432-2323. ; 39:8, s. 2076-2083
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Tidskriftsartikel (refereegranskat)abstract
- Several North American studies have observed survival benefit in patients exposed to beta-blockers following traumatic brain injury (TBI). The purpose of this study was to evaluate the effect of beta-blockade on mortality in a Swedish cohort of isolated severe TBI patients.The trauma registry of an urban academic trauma center was queried to identify patients with an isolated severe TBI between 1/2007 and 12/2011. Isolated severe TBI was defined as an intracranial injury with an Abbreviated Injury Scale (AIS) a parts per thousand yen3 excluding extra-cranial injuries AIS a parts per thousand yen3. Multivariable logistic regression analysis was used to determine the effect of beta-blocker exposure on mortality. Also, a subgroup analysis was performed to investigate the risk of mortality in patients on pre-admission beta-blocker versus not and the effect of specific type of beta-blocker on the overall outcome.Overall, 874 patients met the study criteria. Of these, 33 % (n = 287) were exposed to beta-blockers during their hospital admission. The exposed patients were older (62 +/- A 16 years vs. 49 +/- A 21 years, p < 0.001), and more severely injured based on their admission GCS, ISS, and head AIS scores (GCS a parts per thousand currency sign8: 32 % vs. 28 %, p = 0.007; ISS a parts per thousand yen16: 71 % vs. 59 %, p = 0.001; head AIS a parts per thousand yen4: 60 % vs. 45 %, p < 0.001). The crude mortality was higher in patients who did not receive beta-blockers (17 % vs. 11 %, p = 0.007) during their admission. After adjustment for significant confounders, the patients not exposed to beta-blockers had a 5-fold increased risk of in-hospital mortality (AOR 5.0, CI 95 % 2.7-8.5, p = 0.001). No difference in survival was noted in regards to the type of beta-blocker used. Subgroup analysis revealed a higher risk of mortality in patients naive to beta-blockers compared to those on pre-admission beta-blocker therapy (AOR 3.0 CI 95 % 1.2-7.1, p = 0.015).Beta-blocker exposure after isolated severe traumatic brain injury is associated with significantly improved survival. We also noted decreased mortality in patients on pre-admission beta-blocker therapy compared to patients naive to such treatment. Further prospective studies are warranted.
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