Use of Non-Selective Beta Blockers (NSBB) in Cirrhotic Patients with Bacterial Infections is Associated with Lower Frequency of Sepsis, but not of Acute-On-Chronic Liver Failure (ACLF) or Survival. Results of a Prospective Study

Baldin, Caroline; Victor, Lívia; Piedade, Juliana; Guimarães, Lívia; Rocha, Tânia Rúbia Flores da; Veiga, Zulane; Fernandes, Flávia; Ahmed, E.; Pereira, J.L.

doi:10.1016/s0168-8278(16)00298-1

Cited by 3 publications

(7 citation statements)

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Section: Use Of Nsbbs In Advanced Cirrhosis: Clinical Evidencesupporting

confidence: 64%

“…Although the exact mechanism by which NSBBs may improve outcomes is speculative, the authors proposed that NSBBs reduced systemic inflammation. This association was also suggested in 2 recent studies, (42,54) in which patients admitted with decompensated cirrhosis on NSBBs had a lower white cell count. In a study by Serst e et al (55) in patients with biopsyproven severe alcoholic hepatitis (n 5 139), one of the most frequent triggers for ACLF, mortality was not different between patients treated and not treated with NSBBs (in all cases propranol), but NSBBs were independently associated with the risk of developing AKI.…”

Section: Does Being On Nsbbs Impair Prognosis In Patients With Aclf?supporting

confidence: 61%

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Beta‐blockers in patients with advanced liver disease: Has the dust settled?

2017

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Nonselective beta-blockers (NSBBs) have been the backbone for the treatment of portal hypertension in cirrhosis for the last 3 decades. A publication in 2010 of a prospective observational study suggested that NSBBs could increase mortality in patients with refractory ascites. This opened a controversy about the safety and efficacy of NSBBs in patients with advanced liver disease and led to the publication of a large corpus of observational data assessing the safety of NSBBs in patients with advanced cirrhosis. In this article, we briefly review the clinical pharmacology of NSBBs, the pathophysiological basis for the underlying benefits and harms of NSBBs in advanced cirrhosis, and the evidence in favor and against the use of NSBBs in specific scenarios. Finally, we summarize the current recommendations and propose areas of opportunity for future research. Liver Transplantation 23 1058-1069 2017 AASLD.

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Section: Use Of Nsbbs In Advanced Cirrhosis: Clinical Evidencesupporting

confidence: 64%

Section: Does Being On Nsbbs Impair Prognosis In Patients With Aclf?supporting

confidence: 61%

Beta‐blockers in patients with advanced liver disease: Has the dust settled?

2017

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“…They also suggested that further studies should focus on the direct effect of continuing versus discontinuing NSBB therapy given their noted between-group differences in ACLF severity. 40,43,52 As noted previously, Bhutta et al 43 recently looked at this question of continuing versus discontinuing NSBB therapy and were unable to detect a difference in mortality. It is worth repeating, though, that NSBB discontinuation was primarily driven by decreased blood pressure in their study and that 40% of the discontinuation group reinitiated therapy at some point during hospitalization when they had an improvement in blood pressure.…”

Section: Nsbbs In Infection/sepsis Acute-on-chronic Liver Failure Hccmentioning

confidence: 97%

“…More recently, a prospective observational study was conducted by Pereira et al 52 looking at patients with cirrhosis admitted with bacterial infections. Of the 163 included patients, 104 were receiving a NSBB within the previous 3 months.…”

Section: Nsbbs In Infection/sepsis Acute-on-chronic Liver Failure Hccmentioning

confidence: 99%

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Use of Nonselective β-Blockers in Patients With End-Stage Liver Disease and Select Complications

et al. 2019

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Objective: To review the literature and recommendations for nonselective β-blockers (NSBBs) in the setting of variceal bleeding prophylaxis and decompensated liver disease. Data Sources: Literature search of MEDLINE was performed (1988 to October 2019) using the following search terms: cirrhosis, advanced cirrhosis, β-blocker, decompensation, prophylaxis. Abstracts, peer-reviewed publications, clinical practice guidelines, and product monographs were reviewed. Study Selection and Data Extraction: Relevant English language studies and those conducted in humans were considered for analysis and inclusion. Data Synthesis: Evidence that suggests that NSBBs are harmful in advanced cirrhosis is overshadowed by confounding variables and small patient populations. The majority of the available evidence suggests neutral or beneficial effects on mortality with continuation of NSBBs despite liver disease progression. Based on the available literature, guidelines, and expert consensuses, NSBBs can be considered within this patient population and may have a positive impact on the majority of these patients. Relevance to Patient Care and Clinical Practice: This review summarizes current place in therapy for NSBBs in the setting of cirrhosis and variceal bleeding prophylaxis. It also includes a discussion of the literature for use of NSBBs within the setting of different acute decompensations in which the data and recommendations for use are less clear. Conclusions: Recent evidence shows neutral or positive results for NSBB use in particular decompensation subgroups, which suggests that NSBBs can be used cautiously with close monitoring in patients with advanced cirrhosis. Questions still remain regarding optimal agent and dose and whether agents can be safely restarted after an acute decompensation episode.

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Non-selective β-blockers in advanced cirrhosis: a critical review of the effects on overall survival and renal function

Blasco-Algora

Masegosa-Ataz

Alonso

et al. 2016

BMJ Open Gastroenterol

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IntroductionNon-selective β-blockers (NSBBs) are widely prescribed in patients with cirrhosis for primary and secondary prophylaxis of bleeding oesophageal varices. Furthermore, it has been suggested that the clinical benefits of NSBBs may extend beyond their haemodynamic effects. Recently, a potentially harmful effect has been described in patients with refractory ascites or spontaneous bacterial peritonitis.MethodologyA comprehensive literature search on β-blockers and cirrhosis survival using the electronic databases PubMed/MEDLINE, AMED, CINAHL and the Cochrane Central Register of Controlled Trials. Full-text manuscripts published over more than 35 years, from 1980 to April 2016 were reviewed for relevance and reference lists were cross-checked for additional pertinent studies regarding potential NSBB effects, especially focused on those concerned with survival and/or acute kidney injury (AKI).DiscussionThe proposed review will be able to provide valuable evidence to help decision making in the use of NSBB for the treatment of advanced cirrhosis and highlights some limitations in existing evidence to direct future research.

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Use of Non-Selective Beta Blockers (NSBB) in Cirrhotic Patients with Bacterial Infections is Associated with Lower Frequency of Sepsis, but not of Acute-On-Chronic Liver Failure (ACLF) or Survival. Results of a Prospective Study

Cited by 3 publications

References 0 publications

Beta‐blockers in patients with advanced liver disease: Has the dust settled?

Beta‐blockers in patients with advanced liver disease: Has the dust settled?

Use of Nonselective β-Blockers in Patients With End-Stage Liver Disease and Select Complications

Non-selective β-blockers in advanced cirrhosis: a critical review of the effects on overall survival and renal function

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