{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T06:00:23Z","timestamp":1785218423787,"version":"3.55.0"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sepsis-induced cardiomyopathy (SICM) is a common but underrecognized complication of sepsis and is associated with adverse short- and long-term outcomes. Patients with diabetic kidney disease (DKD) are particularly vulnerable to sepsis-related cardiac dysfunction, potentially due to chronic inflammation and heightened mineralocorticoid receptor (MR) activation. Whether non-steroidal MRAs are associated with a lower risk of SICM compared with steroidal MRAs remains unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using the TriNetX federated electronic health record network, we conducted a retrospective cohort study of adults with DKD and sepsis between 2021 and 2025. Patients initiating finerenone were compared with those initiating steroidal MRAs. Propensity score matching (1:1) was performed to balance baseline characteristics. The primary outcome was SICM, defined by heart failure, cardiogenic shock, pulmonary edema, or left ventricular ejection fraction \u226450%. Secondary outcomes included all-cause mortality and surrogate markers of myocardial injury. Cox proportional hazards models were used to estimate hazard ratios (HRs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After matching, 1,378 patients were included in each group. Finerenone use was associated with a significantly lower risk of SICM compared with steroidal MRAs (3.3% vs 5.2%; HR 0.59, 95% CI 0.40\u20130.87). Finerenone was also associated with lower all-cause mortality (HR 0.45, 95% CI 0.31\u20130.65) and a reduced risk of surrogate myocardial injury outcomes (HR 0.48, 95% CI 0.25\u20130.90). Results were generally directionally similar across several subgroup analyses, although the association was attenuated among patients not receiving SGLT2 inhibitors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this real-world cohort of patients with DKD and sepsis, finerenone use was associated with a lower observed risk of clinically recognized SICM compared with steroidal MRAs. A lower all-cause mortality rate was also observed; however, given the magnitude of this association and the observational design, this finding should be interpreted cautiously and may reflect residual confounding or treatment-selection bias. These findings are hypothesis-generating and require confirmation in prospective studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphar.2026.1837944","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T05:37:42Z","timestamp":1785217062000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative effectiveness of finerenone versus steroidal mineralocorticoid receptor antagonists on sepsis-induced cardiomyopathy in patients with diabetic kidney disease: a real-world cohort study"],"prefix":"10.3389","volume":"17","author":[{"given":"Jheng-Yan","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Nutrition, Chi Mei Medical Center","place":["Tainan, Taiwan"]},{"name":"Department of Public Health, College of Medicine, National Cheng Kung University","place":["Tainan, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keng-Wei","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Cardiology, Chi Mei Medical Center, Chiali","place":["Tainan, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng-Chi","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Medical Education, Chi Mei Medical Center","place":["Tainan, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsuan-Yuan","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Hepatogastroenterology, Chi Mei Medical Centre","place":["Tainan, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Min","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Cardiology, Chi Mei Medical Center","place":["Tainan, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"3339","DOI":"10.1093\/eurheartj\/ehaf340","article-title":"Sepsis-induced cardiomyopathy","volume":"46","author":"Aissaoui","year":"2025","journal-title":"Eur. 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