Lower-dose beta-blocker associated with reduced mortality in decompensated cirrhosis patients

WASHINGTON – Treatment with nonselective beta-blockers was not associated with an increased mortality risk in patients with decompensated cirrhosis, judging from findings from a retrospective longitudinal cohort study using Danish registry data presented by Dr. Ulrich Bang at the annual meeting of the American Association for the Study of Liver Diseases.

However, dose played a role in the mortality risk, with low-dose beta-blocker treatment (40 mg/day or less) reducing the risk of death "in all patients independent of severity of cirrhosis," said Dr. Bang of the department of gastroenterology, University Hospital of Hvidovre, Denmark. High-dose beta-blockers (more than 40 mg/day) were associated with increased mortality among patients with diuretic-resistant ascites as a feature of decompensated cirrhosis, he said. Using data on patients with alcoholic or biliary cirrhosis from the Danish national patient registry and medication use from the country’s national prescription registry, the study addressed the possibility that treatment with beta-blockers may have a negative impact on survival in severely ill cirrhotic patients. Although treatment with beta-blockers reduces the risk of mortality and repeat bleeding in patients with cirrhosis and varices, there has been concern about the possibility that beta-blockers have detrimental effects in patients with diuretic-refractory ascites because of a negative effect on cardiac output, he noted.

The primary outcome was mortality, adjusted for age, comorbidities, sex, and socioeconomic status.

Between 1995 and 2010, there were 1,576 people in the registry with mild decompensated cirrhosis (defined as those who had undergone one to four paracentesis procedures) and 239 people with severe decompensated cirrhosis (they had had more than four paracenteses). There were also 16,828 people with nonresistant "cirrhosis," who had not undergone a paracentesis procedure. Of the total of 18,643 patients, almost 90% had alcoholic cirrhosis, about 21% used a beta-blocker, and 64% used diuretics.

The median beta-blocker dose among the patients with mild cirrhosis was 30 mg/day (range 20-264 mg), and 24 mg/day (16-58 mg) among those with severe cirrhosis.

Among the patients with mild decompensated cirrhosis, mortality was 43% among those on a beta-blocker vs. 58% among those not on a beta-blocker, a significantly decreased risk of death. Among those on a beta-blocker, mortality was 38% among those on 40 mg or less per day vs. 51% among those on higher daily doses.

Mortality was also lower among those treated with a beta-blocker among the 239 patients with severe decompensated cirrhosis, Dr. Bang said. In this group, mortality was 47% among those not on a beta-blocker, compared with 41% of those on a beta-blocker. Of those on a beta-blocker, mortality was 36% among those on a dose of 40 mg or less a day but was 52% among those on more than 40 mg/day. The same patterns were seen in a subgroup of patients with diuretic-resistant decompensated cirrhosis.

The use of a beta-blocker was associated with a lower risk of spontaneous bacterial peritonitis in patients with decompensated cirrhosis, he said.

Dr. Bang had no disclosures.

[email protected]

WASHINGTON – Treatment with nonselective beta-blockers was not associated with an increased mortality risk in patients with decompensated cirrhosis, judging from findings from a retrospective longitudinal cohort study using Danish registry data presented by Dr. Ulrich Bang at the annual meeting of the American Association for the Study of Liver Diseases.

However, dose played a role in the mortality risk, with low-dose beta-blocker treatment (40 mg/day or less) reducing the risk of death "in all patients independent of severity of cirrhosis," said Dr. Bang of the department of gastroenterology, University Hospital of Hvidovre, Denmark. High-dose beta-blockers (more than 40 mg/day) were associated with increased mortality among patients with diuretic-resistant ascites as a feature of decompensated cirrhosis, he said. Using data on patients with alcoholic or biliary cirrhosis from the Danish national patient registry and medication use from the country’s national prescription registry, the study addressed the possibility that treatment with beta-blockers may have a negative impact on survival in severely ill cirrhotic patients. Although treatment with beta-blockers reduces the risk of mortality and repeat bleeding in patients with cirrhosis and varices, there has been concern about the possibility that beta-blockers have detrimental effects in patients with diuretic-refractory ascites because of a negative effect on cardiac output, he noted.

The primary outcome was mortality, adjusted for age, comorbidities, sex, and socioeconomic status.

Between 1995 and 2010, there were 1,576 people in the registry with mild decompensated cirrhosis (defined as those who had undergone one to four paracentesis procedures) and 239 people with severe decompensated cirrhosis (they had had more than four paracenteses). There were also 16,828 people with nonresistant "cirrhosis," who had not undergone a paracentesis procedure. Of the total of 18,643 patients, almost 90% had alcoholic cirrhosis, about 21% used a beta-blocker, and 64% used diuretics.

The median beta-blocker dose among the patients with mild cirrhosis was 30 mg/day (range 20-264 mg), and 24 mg/day (16-58 mg) among those with severe cirrhosis.

Among the patients with mild decompensated cirrhosis, mortality was 43% among those on a beta-blocker vs. 58% among those not on a beta-blocker, a significantly decreased risk of death. Among those on a beta-blocker, mortality was 38% among those on 40 mg or less per day vs. 51% among those on higher daily doses.

Mortality was also lower among those treated with a beta-blocker among the 239 patients with severe decompensated cirrhosis, Dr. Bang said. In this group, mortality was 47% among those not on a beta-blocker, compared with 41% of those on a beta-blocker. Of those on a beta-blocker, mortality was 36% among those on a dose of 40 mg or less a day but was 52% among those on more than 40 mg/day. The same patterns were seen in a subgroup of patients with diuretic-resistant decompensated cirrhosis.

The use of a beta-blocker was associated with a lower risk of spontaneous bacterial peritonitis in patients with decompensated cirrhosis, he said.

Dr. Bang had no disclosures.

[email protected]

WASHINGTON – Treatment with nonselective beta-blockers was not associated with an increased mortality risk in patients with decompensated cirrhosis, judging from findings from a retrospective longitudinal cohort study using Danish registry data presented by Dr. Ulrich Bang at the annual meeting of the American Association for the Study of Liver Diseases.

However, dose played a role in the mortality risk, with low-dose beta-blocker treatment (40 mg/day or less) reducing the risk of death "in all patients independent of severity of cirrhosis," said Dr. Bang of the department of gastroenterology, University Hospital of Hvidovre, Denmark. High-dose beta-blockers (more than 40 mg/day) were associated with increased mortality among patients with diuretic-resistant ascites as a feature of decompensated cirrhosis, he said. Using data on patients with alcoholic or biliary cirrhosis from the Danish national patient registry and medication use from the country’s national prescription registry, the study addressed the possibility that treatment with beta-blockers may have a negative impact on survival in severely ill cirrhotic patients. Although treatment with beta-blockers reduces the risk of mortality and repeat bleeding in patients with cirrhosis and varices, there has been concern about the possibility that beta-blockers have detrimental effects in patients with diuretic-refractory ascites because of a negative effect on cardiac output, he noted.

The primary outcome was mortality, adjusted for age, comorbidities, sex, and socioeconomic status.

Between 1995 and 2010, there were 1,576 people in the registry with mild decompensated cirrhosis (defined as those who had undergone one to four paracentesis procedures) and 239 people with severe decompensated cirrhosis (they had had more than four paracenteses). There were also 16,828 people with nonresistant "cirrhosis," who had not undergone a paracentesis procedure. Of the total of 18,643 patients, almost 90% had alcoholic cirrhosis, about 21% used a beta-blocker, and 64% used diuretics.

The median beta-blocker dose among the patients with mild cirrhosis was 30 mg/day (range 20-264 mg), and 24 mg/day (16-58 mg) among those with severe cirrhosis.

Among the patients with mild decompensated cirrhosis, mortality was 43% among those on a beta-blocker vs. 58% among those not on a beta-blocker, a significantly decreased risk of death. Among those on a beta-blocker, mortality was 38% among those on 40 mg or less per day vs. 51% among those on higher daily doses.

Mortality was also lower among those treated with a beta-blocker among the 239 patients with severe decompensated cirrhosis, Dr. Bang said. In this group, mortality was 47% among those not on a beta-blocker, compared with 41% of those on a beta-blocker. Of those on a beta-blocker, mortality was 36% among those on a dose of 40 mg or less a day but was 52% among those on more than 40 mg/day. The same patterns were seen in a subgroup of patients with diuretic-resistant decompensated cirrhosis.

The use of a beta-blocker was associated with a lower risk of spontaneous bacterial peritonitis in patients with decompensated cirrhosis, he said.

Dr. Bang had no disclosures.

[email protected]