@article{3180470,
    title = "Nonselective Beta-Blockers Do Not Affect Survival in Cirrhotic Patients
with Ascites",
    author = "Facciorusso, Antonio and Roy, Sunil and Livadas, Sarantis and and Fevrier-Paul, Adwalia and Wekesa, Clara and Kilic, Ismail Dogu and and Chaurasia, Amit Kumar and Sadeq, Mina and Muscatiello, Nicola",
    journal = "Digestive Diseases and Sciences",
    year = "2018",
    volume = "63",
    number = "7",
    pages = "1737-1746",
    publisher = "Springer-Verlag",
    issn = "0163-2116, 1573-2568",
    doi = "10.1007/s10620-018-5092-6",
    keywords = "NSBB; Cirrhosis; Mortality; Hazard ratio",
    abstract = "The role of nonselective beta-blockers in cirrhotic patients with
ascites has been recently questioned; however, definitive evidence in
this regard is still lacking.
To analyze published data on the influence of nonselective beta-blockers
as compared to control group on survival of cirrhotic patients with
ascites.
Computerized bibliographic search on the main databases was performed.
Hazard ratios from Kaplan-Meier curves were extracted in order to
perform an unbiased comparison of survival estimates. Secondary outcomes
were mortality in patients with refractory ascites, pooled rate of
nonselective beta-blockers interruption, spontaneous bacterial
peritonitis and hepato-renal syndrome incidence.
Three randomized controlled trials and 13 observational studies with
8279 patients were included. Overall survival was comparable between the
two groups (hazard ratio = 0.86, 0.71-1.03, p = 0.11). Study design
resulted as the main source of heterogeneity in sensitivity analysis and
meta-regression. Mortality in refractory ascites patients was similar in
the two groups (odds ratio = 0.90, 0.45-1.79; p = 0.76). No difference
in spontaneous bacterial peritonitis (odds ratio = 0.78, 0.47-1.29, p =
0.33) and hepato-renal syndrome incidence (odds ratio = 1.22, 0.48-3.09;
p = 0.67) was observed. Pooled rate of nonselective beta-blockers
interruption was 18.6% (5.2-32.1%).
Based on our findings, nonselective beta-blockers should not be
routinely withheld in patients with cirrhosis and ascites, even if
refractory."
}