Beta-blockers in hospitalised patients with cirrhosis and ascites: mortality and factors determining discontinuation and reinitiation

A. Q. Bhutta, G. Garcia-Tsao, K. R. Reddy, P. Tandon, F. Wong, J. G. O'Leary, C. Acharya, D. Banerjee, J. G. Abraldes, T. M. Jones, J. Shaw, Y. Deng, M. Ciarleglio, J. S. Bajaj

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Abstract

Background: It has been suggested that beta-blockers may increase mortality in patients with cirrhosis and refractory ascites but the effect of beta-blockers discontinuation or reinitiation has not been examined. Aims: To compare, in hospitalised patients with cirrhosis and ascites, the effect of BB on survival and to examine the effect/predictors of beta-blockers discontinuation and reinitiation. Methods: Sub-analysis of NACSELD (North American consortium for the study of end-stage liver disease, database containing prospective data on hospitalised patients with cirrhosis) data from 7 centres enrolling >100 patients with ascites. Data on BB discontinuation and reinitiation were collected by chart review. Results: Seven hundred and sixteen patients, 307 (43%) on beta-blockers at admission and 366 (51%) with refractory ascites, were followed to death or hospital discharge. Beta-blocker use was associated with a lower white blood cell count at admission. Beta-blocker use in hospitalised patients with ascites was not associated with a higher mortality, even in those with refractory ascites. No significant changes in mean arterial pressure (MAP) were observed between groups. Discontinuation of beta-blockers (49%) was driven by low MAP, infection and acute kidney injury at time of discontinuation but was not associated with a higher mortality. Beta-blocker reinitiation occurred in 40% prior to discharge and was mainly driven by an increase in MAP. Conclusions: Beta-blocker use is safe in patients with cirrhosis and ascites (including those with refractory ascites) provided beta-blockers are discontinued in the presence of a low MAP and reinitiated once MAP reincreases. A potentially beneficial anti-inflammatory effect of beta-blockers is suggested.

Original languageEnglish (US)
Pages (from-to)78-85
Number of pages8
JournalAlimentary Pharmacology and Therapeutics
Volume47
Issue number1
DOIs
StatePublished - Jan 1 2018

ASJC Scopus subject areas

  • Pharmacology (medical)

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    Bhutta, A. Q., Garcia-Tsao, G., Reddy, K. R., Tandon, P., Wong, F., O'Leary, J. G., Acharya, C., Banerjee, D., Abraldes, J. G., Jones, T. M., Shaw, J., Deng, Y., Ciarleglio, M., & Bajaj, J. S. (2018). Beta-blockers in hospitalised patients with cirrhosis and ascites: mortality and factors determining discontinuation and reinitiation. Alimentary Pharmacology and Therapeutics, 47(1), 78-85. https://doi.org/10.1111/apt.14366