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Aliment Pharmacol Ther. 2018 Jan;47(1):78-85. doi: 10.1111/apt.14366. Epub 2017 Oct 9.

Beta-blockers in hospitalised patients with cirrhosis and ascites: mortality and factors determining discontinuation and reinitiation.

Author information

1
Yale-New Haven Hospitalist Service, Yale-New Haven Hospital, New Haven, CT, USA.
2
Section of Digestive Diseases, Yale University, New Haven, CT, USA.
3
Section of Digestive Diseases, VA-CT Healthcare System, West Haven, CT, USA.
4
University of Pennsylvania, Philadelphia, PA, USA.
5
University of Alberta, Edmonton, Canada, USA.
6
University of Toronto, Toronto, Canada, USA.
7
Baylor University Medical Center, Dallas, USA.
8
Virginia Commonwealth University, Richmond, VA, USA.
9
McGuire VA Medical Center, Richmond, VA, USA.
10
Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA.

Abstract

BACKGROUND:

It has been suggested that beta-blockers may increase mortality in patients with cirrhosis and refractory ascites but the effect of beta-blockers discontinuation or reinitiation has not been examined.

AIMS:

To compare, in hospitalised patients with cirrhosis and ascites, the effect of BB on survival and to examine the effect/predictors of beta-blockers discontinuation and reinitiation.

METHODS:

Sub-analysis of NACSELD (North American consortium for the study of end-stage liver disease, database containing prospective data on hospitalised patients with cirrhosis) data from 7 centres enrolling >100 patients with ascites. Data on BB discontinuation and reinitiation were collected by chart review.

RESULTS:

Seven hundred and sixteen patients, 307 (43%) on beta-blockers at admission and 366 (51%) with refractory ascites, were followed to death or hospital discharge. Beta-blocker use was associated with a lower white blood cell count at admission. Beta-blocker use in hospitalised patients with ascites was not associated with a higher mortality, even in those with refractory ascites. No significant changes in mean arterial pressure (MAP) were observed between groups. Discontinuation of beta-blockers (49%) was driven by low MAP, infection and acute kidney injury at time of discontinuation but was not associated with a higher mortality. Beta-blocker reinitiation occurred in 40% prior to discharge and was mainly driven by an increase in MAP.

CONCLUSIONS:

Beta-blocker use is safe in patients with cirrhosis and ascites (including those with refractory ascites) provided beta-blockers are discontinued in the presence of a low MAP and reinitiated once MAP reincreases. A potentially beneficial anti-inflammatory effect of beta-blockers is suggested.

PMID:
28994122
PMCID:
PMC6016372
[Available on 2019-01-01]
DOI:
10.1111/apt.14366
[Indexed for MEDLINE]

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