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Clinical Efficacy of Beta-1 Selective Beta-Blockers Versus Propranolol in Patients With Thyroid Storm: A Retrospective Cohort Study.
Matsuo, Yuichiro; Jo, Taisuke; Watanabe, Hideaki; Matsui, Hiroki; Fushimi, Kiyohide; Yasunaga, Hideo.
Afiliación
  • Matsuo Y; Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan.
  • Jo T; Department of Health Services Research, University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan.
  • Watanabe H; Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan.
  • Matsui H; Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan.
  • Fushimi K; Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Yushima, Bunkyo-ku, Tokyo, Japan.
  • Yasunaga H; Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan.
Crit Care Med ; 52(7): 1077-1086, 2024 Jul 01.
Article en En | MEDLINE | ID: mdl-38551468
ABSTRACT

OBJECTIVES:

Thyroid storm is the most severe manifestation of thyrotoxicosis. Beta-blockers are among the standard treatment regimens for this condition, with propranolol being the historically preferred option. However, 2016 guidelines issued by the Japan Thyroid Association and the Japan Endocrine Society recommend the use of beta-1 selective beta-blockers over nonselective beta-blockers, such as propranolol. Nevertheless, evidence supporting this recommendation is limited. Herein, we aimed to investigate the in-hospital mortality of patients with thyroid storms based on the choice of beta-blockers.

DESIGN:

Retrospective cohort study.

SETTING:

The Diagnosis Procedure Combination database, a national inpatient database in Japan. PATIENTS Patients hospitalized with thyroid storm between April 2010 and March 2022.

INTERVENTIONS:

Propensity-score overlap weighting was performed to compare in-hospital mortality between patients who received beta-1 selective beta-blockers and those who received propranolol. Subgroup analysis was also conducted, considering the presence or absence of acute heart failure. MEASUREMENTS AND MAIN

RESULTS:

Among the 2462 eligible patients, 1452 received beta-1 selective beta-blockers and 1010 received propranolol. The crude in-hospital mortality rates were 9.3% for the beta-1 selective beta-blocker group and 6.2% for the propranolol group. After adjusting for baseline variables, the use of beta-1 selective beta-blockers was not associated with lower in-hospital mortality (6.3% vs. 7.4%; odds ratio, 0.85; 95% CI, 0.57-1.26). Furthermore, no significant difference in in-hospital mortality was observed in patients with acute heart failure.

CONCLUSIONS:

In patients with thyroid storm, the choice between beta-1 selective beta-blockers and propranolol did not affect in-hospital mortality, regardless of the presence of acute heart failure. Therefore, both beta-1 selective beta-blockers and propranolol can be regarded as viable treatment options for beta-blocker therapy in cases of thyroid storm, contingent upon the clinical context.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Propranolol / Crisis Tiroidea / Mortalidad Hospitalaria Límite: Adult / Aged / Female / Humans / Male / Middle aged País/Región como asunto: Asia Idioma: En Revista: Crit Care Med Año: 2024 Tipo del documento: Article País de afiliación: Japón Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Propranolol / Crisis Tiroidea / Mortalidad Hospitalaria Límite: Adult / Aged / Female / Humans / Male / Middle aged País/Región como asunto: Asia Idioma: En Revista: Crit Care Med Año: 2024 Tipo del documento: Article País de afiliación: Japón Pais de publicación: Estados Unidos