Atif Zaman, MD, MPH

Beta-blocker therapy was associated with increased risk for poor outcomes in patients with spontaneous bacterial peritonitis.

Beta-blockers are routinely used for primary and secondary prevention of variceal hemorrhage in patients with cirrhosis. However, recent evidence suggests that beta-blocker therapy is safe and effective in middle stages of cirrhosis but may be detrimental in late stages (NEJM JW Gastroenterol Mar 18 2014). In the current study, researchers retrospectively analyzed the safety of beta-blocker therapy in patients with cirrhosis and ascites with and without spontaneous bacterial peritonitis (SBP).

Study patients had undergone their first paracentesis. Available data included development of SBP, beta-blocker use, variceal bleeding history, liver transplantation, and mortality. Cox regression models were calculated to investigate the effect of beta-blockers on transplant-free survival (time to liver transplantation, death, or end of follow-up) adjusted for Child-Pugh score and presence of varices.

Among 607 total patients (median model for end-stage liver disease score, 17.5), 245 received beta-blockers and 182 developed SBP (86 were on beta-blockers) during 660 person-years of follow-up. Beta-blocker therapy was associated with increased transplant-free survival in patients without SBP (hazard ratio, 0.75; 95% confidence interval, 0.581–0.968) but was associated with decreased transplant-free survival in patients with SBP (HR, 1.58; 95% CI, 1.098–2.274). Higher proportions of patients who received beta-blockers developed hepatorenal syndrome (24% vs. 11%; P=0.027) and grade C acute kidney injury (20% vs. 8%; P=0.021).

Citation(s):

Mandorfer M et al. Nonselective β blockers increase risk for hepatorenal syndrome and death in patients with cirrhosis and spontaneous bacterial peritonitis. Gastroenterology 2014 Jun; 146:1680.