eprintid: 10160251 rev_number: 9 eprint_status: archive userid: 699 dir: disk0/10/16/02/51 datestamp: 2022-11-24 16:02:40 lastmod: 2024-10-29 20:04:12 status_changed: 2022-11-24 16:02:40 type: article metadata_visibility: show sword_depositor: 699 creators_name: Tittanegro, T creators_name: China, L creators_name: Forrest, E creators_name: Kallis, Y creators_name: Ryder, SD creators_name: Wright, G creators_name: Freemantle, N creators_name: O'Brien, A title: Use of non-selective B-blockers is safe in hospitalised decompensated cirrhosis patients and exerts a potential anti-inflammatory effect: Data from the ATTIRE trial ispublished: pub subjects: RFH divisions: UCL divisions: B02 divisions: C10 divisions: D17 divisions: D20 divisions: D65 divisions: G91 divisions: H20 keywords: Renal dysfunction; Interleukin-8; White cell count; infection note: Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). abstract: Background: Nonselective B-blockers (NSBBs) are believed to have pleiotropic effects beyond reducing portal pressure. However, studies also report potential harm in patients hospitalized with cirrhosis and ascites. We therefore investigated whether NSBB use at ATTIRE trial entry (Albumin to prevent infection in chronic liver failure, 2016-19) was associated with increased renal or cardiovascular dysfunction, compared the incidence of infection and plasma markers of systemic inflammation, and examined mortality at 28-days, 3 and 6-months. Methods: In ATTIRE patients grouped by NSBB use at trial entry, we studied infection at baseline, hospital acquired infection and organ dysfunction during trial treatment period and mortality, with propensity score matching to account for differences in disease severity. Findings: There were no differences in renal or cardiovascular dysfunction between patients treated with NSBBs or not, during days 3–15 of hospitalization, despite elevated serum creatinine in NSBB patients at hospitalisation. Use of NSBBs was associated with a significant reduction in infection at hospitalization (p = 0.006), lower white cell counts throughout hospital stay (p < 0.001) and reduced plasma procalcitonin (p = 0.009) and interlukin-8 levels (p = 0.04) at baseline, but markers of bacterial translocation and systemic inflammation were the same in treatment groups. There was no reduction in hospital acquired infections in patients taking NSBBs and no beneficial impact on mortality at 28-days, 3 and 6-months. Interpretations: Our real-world data from a completed randomised trial show that use of NSBBs in decompensated cirrhosis patients is safe during hospitalisation. We also show a potential anti-inflammatory role for NSBBs which may be mediated by a downregulation of IL-8 induced leucocytosis, that was associated with reduced infection at baseline but not a survival benefit. Funding: Wellcome Trust and Department of Health and Social Care. date: 2023-01-01 date_type: published publisher: Elsevier BV official_url: https://doi.org/10.1016/j.eclinm.2022.101716 oa_status: green full_text_type: pub language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 1990370 doi: 10.1016/j.eclinm.2022.101716 lyricists_name: O'Brien, Alastair lyricists_name: Freemantle, Nicholas lyricists_name: China, Louise lyricists_id: AJOBR19 lyricists_id: NDRFR82 lyricists_id: LCHIN33 actors_name: Flynn, Bernadette actors_id: BFFLY94 actors_role: owner full_text_status: public publication: eClinicalMedicine volume: 55 article_number: 101716 citation: Tittanegro, T; China, L; Forrest, E; Kallis, Y; Ryder, SD; Wright, G; Freemantle, N; Tittanegro, T; China, L; Forrest, E; Kallis, Y; Ryder, SD; Wright, G; Freemantle, N; O'Brien, A; - view fewer <#> (2023) Use of non-selective B-blockers is safe in hospitalised decompensated cirrhosis patients and exerts a potential anti-inflammatory effect: Data from the ATTIRE trial. eClinicalMedicine , 55 , Article 101716. 10.1016/j.eclinm.2022.101716 <https://doi.org/10.1016/j.eclinm.2022.101716>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10160251/1/1-s2.0-S2589537022004461-main.pdf