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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| Vydáno v: | Hepatology international Ročník 15; číslo 2; s. 424 - 436 |
|---|---|
| Hlavní autoři: | , , , , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
| Vydáno: |
New Delhi
Springer India
01.04.2021
Springer Nature B.V |
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| ISSN: | 1936-0533, 1936-0541, 1936-0541 |
| On-line přístup: | Získat plný text |
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| Abstract | 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. |
|---|---|
| AbstractList | Background/AimWe 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.MethodsWe 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).ResultsIn 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).ConclusionNSBB 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. 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.BACKGROUND/AIMWe 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.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).METHODSWe 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).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).RESULTSIn 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).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.CONCLUSIONNSBB 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. 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. 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). 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). 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. 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. |
| Author | Kim, Dong Joon Kang, Seong Hee Lee, Minjong Lee, Jun Hyeok Jun, Baek Gyu Kim, Young Don Cheon, Gab Jin Kim, Tae Suk Choi, Dae Hee Baik, Soon Koo Kim, Moon Young Suk, Ki Tae |
| Author_xml | – sequence: 1 givenname: Seong Hee surname: Kang fullname: Kang, Seong Hee organization: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Regenerative Medicine Research Center, Yonsei University Wonju College of Medicine, Cell Therapy and Tissue Engineering Center, Yonsei University Wonju College of Medicine – sequence: 2 givenname: Minjong surname: Lee fullname: Lee, Minjong organization: School of Medicine, Ewha Womans University, Department of Internal Medicine, Kangwon National University Hospital – sequence: 3 givenname: Moon Young orcidid: 0000-0002-2501-2206 surname: Kim fullname: Kim, Moon Young email: drkimmy@yonsei.ac.kr organization: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Regenerative Medicine Research Center, Yonsei University Wonju College of Medicine, Cell Therapy and Tissue Engineering Center, Yonsei University Wonju College of Medicine – sequence: 4 givenname: Jun Hyeok surname: Lee fullname: Lee, Jun Hyeok organization: Department of Biostatistics, Yonsei University Wonju College of Medicine, Yonsei University – sequence: 5 givenname: Baek Gyu surname: Jun fullname: Jun, Baek Gyu organization: Department of Internal Medicine, University of Ulsan College of Medicine, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine – sequence: 6 givenname: Tae Suk surname: Kim fullname: Kim, Tae Suk organization: Department of Internal Medicine, Kangwon National University Hospital – sequence: 7 givenname: Dae Hee surname: Choi fullname: Choi, Dae Hee organization: Department of Internal Medicine, Kangwon National University Hospital – sequence: 8 givenname: Ki Tae surname: Suk fullname: Suk, Ki Tae organization: Department of Internal Medicine, Hallym University College of Medicine – sequence: 9 givenname: Young Don surname: Kim fullname: Kim, Young Don organization: Department of Internal Medicine, University of Ulsan College of Medicine – sequence: 10 givenname: Gab Jin surname: Cheon fullname: Cheon, Gab Jin organization: Department of Internal Medicine, University of Ulsan College of Medicine – sequence: 11 givenname: Dong Joon surname: Kim fullname: Kim, Dong Joon organization: Department of Internal Medicine, Hallym University College of Medicine – sequence: 12 givenname: Soon Koo surname: Baik fullname: Baik, Soon Koo organization: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Regenerative Medicine Research Center, Yonsei University Wonju College of Medicine, Cell Therapy and Tissue Engineering Center, Yonsei University Wonju College of Medicine |
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| Keywords | Treatment Portal hypertension Hepatic venous pressure gradient Severity Ascites Liver cirrhosis Survival Low-dose non-selective β-blockers Nonselective β-blockers Esophageal varix |
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We investigated the effect of non-selective β-blockers (NSBB) in real-world situations and whether low-dose NSBB is beneficial compared to... 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... Background/AimWe investigated the effect of non-selective β-blockers (NSBB) in real-world situations and whether low-dose NSBB is beneficial compared to... |
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| SubjectTerms | 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 |
| Title | The longitudinal outcomes of applying non-selective beta-blockers in portal hypertension: real-world multicenter study |
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