The longitudinal outcomes of applying non-selective beta-blockers in portal hypertension: real-world multicenter study

Background/Aim We investigated the effect of non-selective β-blockers (NSBB) in real-world situations and whether low-dose NSBB is beneficial compared to maximally tolerated doses. Methods We performed a retrospective study of 740 patients with cirrhosis requiring prophylactic treatment of esophagea...

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Published in:Hepatology international Vol. 15; no. 2; pp. 424 - 436
Main Authors: Kang, Seong Hee, Lee, Minjong, Kim, Moon Young, Lee, Jun Hyeok, Jun, Baek Gyu, Kim, Tae Suk, Choi, Dae Hee, Suk, Ki Tae, Kim, Young Don, Cheon, Gab Jin, Kim, Dong Joon, Baik, Soon Koo
Format: Journal Article
Language:English
Published: New Delhi Springer India 01.04.2021
Springer Nature B.V
Subjects:
Ascites
Beta blockers
Cirrhosis
Colorectal Surgery
Disease prevention
Esophagus
Health risks
Hepatology
Hypertension
Liver cirrhosis
Medicine
Medicine & Public Health
Mortality
Original Article
Prophylaxis
Risk management
Risk reduction
Surgery
Survival
Treatment
Portal hypertension
Hepatic venous pressure gradient
Severity
Ascites
Liver cirrhosis
Survival
Low-dose non-selective β-blockers
Nonselective β-blockers
Esophageal varix
ISSN:1936-0533, 1936-0541, 1936-0541
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Summary:Background/Aim We investigated the effect of non-selective β-blockers (NSBB) in real-world situations and whether low-dose NSBB is beneficial compared to maximally tolerated doses. Methods We performed a retrospective study of 740 patients with cirrhosis requiring prophylactic treatment of esophageal varices: 473 primary prophylaxis (PP: NSBB = 349, non-NSBB = 124) and 267 secondary prophylaxis (SP: NSBB = 200, non-NSBB = 67). The NSBB group was divided into low-dose (≤ 80 mg/day) and high-dose (> 80 mg/day). Results In the PP group, NSBB treatment reduced mortality and showed the most pronounced effect in patients with moderate/severe ascites (hazard ratio [HR], 0.46; p  < 0.01), HVPG ≥ 16 mmHg (HR, 0.53; p  = 0.04), or CTP class B/C (HR, 0.46; p  < 0.01) but not in those with no/mild ascites, HVPG < 16 mmHg, or CTP class A. Low-dose NSBB group showed a significant reduction in mortality compared with non-NSBB (moderate/severe ascites: HR, 0.61; p  = 0.02 and CTP class B/C: HR, 0.41; p  < 0.01) and the effect size was stronger than the high-dose NSBB. NSBB was associated with a reduced risk of infection (HR, 0.36; p  = 0.01). In the SP group, NSBB prolonged survival in patients with moderate/severe ascites (HR, 0.56; p  = 0.02), HVPG ≥ 16 mmHg (HR, 0.42; p  < 0.01), or CTP class B/C (HR, 0.52; p  < 0.01). Low-dose NSBB was more beneficial with 56% risk reduction ( p  < 0.01) of mortality compared with 33% risk reduction in the high-dose NSBB ( p  = 0.05). Conclusion NSBB therapy was associated with longer survival in PP and SP groups who had an advanced stage of cirrhosis. Moreover, low-dose NSBB exhibited a better benefit than a standard-titrated high-dose NSBB with better tolerability.
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ISSN:1936-0533
1936-0541
1936-0541
DOI:10.1007/s12072-021-10160-3