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Non-selective beta-blockers are not associated with increased mortality in cirrhotic patients with ascites

Onali, S; Kalafateli, M; Majumdar, A; Westbrook, R; O'Beirne, J; Leandro, G; Patch, D; (2017) Non-selective beta-blockers are not associated with increased mortality in cirrhotic patients with ascites. Liver International , 37 (9) pp. 1334-1344. 10.1111/liv.13409. Green open access

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Abstract

BACKGROUND & AIMS: Controversy exists on the impact of non-selective beta-blockers (NSBBs) on survival in patients with ascites. We assessed whether NSBB treatment affects survival in a cohort of 316 consecutive patients with ascites undergoing evaluation for liver transplantation. METHODS: Consecutive patients with cirrhosis and ascites assessed for liver transplantation between 2011-2014 were retrospectively evaluated. Cox regression and competing risk analysis were performed to identify predictors of survival. RESULTS: 316 patients were evaluated: males 229 (73%), mean age 54 years, median follow-up: 7 months. Refractory ascites was diagnosed in 124 (39%) patients. Patients receiving NSBBs (n=128, 40.5%) had a higher frequency of previous spontaneous bacterial peritonitis (27% vs. 17%, p=0.025), lower frequency of refractory ascites (32% vs. 44%, p=0.03) but similar MELD and UKELD scores. Overall 80 (25%) patients died: 20 (16%) in the NSBB group vs. 60 (32%) in the non-NSBB group (p=0.002). In multivariate competing risk Cox regression analysis, NSBB use was associated with reduced mortality (HR=0.55, 95%CI=0.33-0.94) along with prophylactic antibiotic use (HR=0.33, 95%CI=0.14-0.74), MELD score (HR=1.10, 95%CI= 1.06-1.14) and sodium levels (HR=0.94, 95%CI 0.89-0.98).. No impact on survival was found when considering only patients with refractory ascites (NSBB use: HR=0.43, 95%CI=0.20-1.11). CONCLUSIONS: Patients with ascites on NSBBs didn't have impaired survival compared to those not receiving NSSBs and interestingly this observation was also confirmed in the subgroup with refractory ascites. Our results suggest that NSBBs are not detrimental, but instead seem safe even in more advanced stages of cirrhosis in patients on a transplant waiting list.

Type: Article
Title: Non-selective beta-blockers are not associated with increased mortality in cirrhotic patients with ascites
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/liv.13409
Publisher version: http://dx.doi.org/10.1111/liv.13409
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: carvedilol, prognosis, propranolol, spontaneous bacterial peritonitis
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inst for Liver and Digestive Hlth
URI: https://discovery.ucl.ac.uk/id/eprint/1545251
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