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