Abstract
Background
Patients with cirrhosis and portal hypertensive complications have reduced survival.
As such, it has been suggested that nonselective beta-blocker therapy in patients
with advanced ascites is harmful. The aim of this study was, therefore, to determine
the risk of mortality in patients with cirrhosis and ascites taking nonselective beta-blocker
therapy for the prevention of variceal hemorrhage.
Materials and Methods
This study was a retrospective analysis of 2,419 patients with cirrhosis and portal
hypertension admitted to Parkland Memorial Hospital (a university-affiliated county
teaching hospital) from 2003-2010. Patients were subdivided into those with varices
only, ascites only and those with both varices and ascites. The primary outcome measure
for this study was all-cause in-hospital mortality.
Results
Overall, 68 of 1,039 (6.5%) patients taking beta-blockers died during their hospitalization,
while 223 of 1,380 (16.2%) patients not taking beta-blockers died (P < 0.001). Beta-blocker use was also assessed in specific cohorts; mortality was 21.1%
in patients with severe ascites with varices who were not taking beta-blockers compared
with 8.9% in patients who were taking beta-blockers (P = 0.05). Overall, fewer patients taking beta-blockers died compared with those not
taking beta-blockers in patients with varices only (6.4% versus 12.1%) and those with
ascites with or without varices (6.6% versus 18.1%) (P < 0.001).
Conclusions
Mortality was lower in patients with cirrhosis and portal hypertension taking nonselective
beta-blockers than in those not taking beta-blockers. The use of nonselective beta-blockers
provided a significant survival benefit in patients with all grades of ascites, including
those with severe ascites.
Key Indexing Terms
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Article info
Publication history
Accepted:
October 21,
2015
Received:
July 7,
2015
Footnotes
The authors certify that they have no financial arrangements (eg, consultancies, stock ownership, equity interests, patent-licensing arrangements, research support and honoraria) with a company whose product figures prominently in this article or with a company making a competing product.
The authors have no financial or other conflicts of interest to disclose.
Identification
Copyright
© 2016 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
