Key result
In patients with end-stage cirrhosis, nonselective β-blocker therapy at discharge did not significantly affect 24-month mortality compared to no therapy (32.0% vs 38.5%; adjusted OR 1.05).
Why the study?
Data regarding the safety of nonselective beta-blockers in patients with end-stage cirrhosis are conflicting, making it difficult to justify whether benefits outweigh risks.
Does nonselective β-blocker use affect 24-month mortality in patients with end-stage cirrhosis who received octreotide for a variceal bleed?
Cohort (n=255)
Yes
Does nonselective β-blocker use affect 24-month mortality in patients with end-stage cirrhosis who received octreotide for a variceal bleed?
Odds Ratio: 1.05 (95% CI 0.32–3.4)
Absolute Event Rate: 32% vs 38.5%
p-value: p=0.51
In patients with end-stage cirrhosis and recent variceal bleed, the use of nonselective beta-blockers at discharge did not significantly affect 24-month mortality.
Does not support nonselective β-blocker use for survival benefit in end-stage cirrhosis; leaves open need for randomized confirmation.
Background: Data regarding safety of nonselective β-blockers (NSBBs) in patients with end-stage cirrhosis are conflicting, making it difficult for practitioners to justify if benefits outweigh the risks. Objective: Evaluate the effect of NSBB use on mortality in patients with end-stage cirrhosis. Methods: We performed a dual-center retrospective study of patients who received octreotide for a variceal bleed. Patients were stratified into 2 groups based on whether or not a NSBB was prescribed at hospital discharge. The primary outcome was 24-month mortality. Multivariable logistic regression, with 24-month mortality as the dependent variable, was performed to identify independent risk factors for the primary outcome. Results: 255 patients met inclusion criteria; 24-month mortality was 32.8%. The NSBB and no-NSBB groups had similar mortality rates at 24 months (32.0% vs 38.5%, P = 0.51). Mortality at 3 months (11.6% vs 23.3%, P = 0.08) and 12 months (22.2% vs 30.0%, P = 0.36) were similar, and there were no differences in rate of variceal bleeding (22.7% vs 13.3%, P = 0.34) or cirrhosis-related cause of death (20.4% vs 23.3%, P = 0.81). In the multivariable model, age, model for end-stage liver disease with sodium and hepatocellular carcinoma were independent risk factors for 24-month mortality. NSBB therapy had no effect on 24-month mortality (adjusted odds ratio = 1.05; 95% CI = 0.32 to 3.40). Conclusion and Relevance: In patients with end-stage cirrhosis, use of NSBBs did not affect 24-month mortality. More research is needed to determine when, and if, NSBBs should be discontinued in end-stage cirrhosis.
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Snoga et al. (2019) conducted a cohort in End-stage cirrhosis (n=255). Nonselective β-blockers (NSBBs) vs. No NSBB prescribed at hospital discharge was evaluated on 24-month mortality (adjusted OR 1.05, 95% CI 0.32 to 3.40, p=0.51). In patients with end-stage cirrhosis, nonselective β-blocker therapy at discharge did not significantly affect 24-month mortality compared to no therapy (32.0% vs 38.5%; adjusted OR 1.05).
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