TY - JOUR
TI - Nonselective Beta-Blockers Do Not Affect Survival in Cirrhotic Patients
with Ascites
AU - Facciorusso, Antonio
AU - Roy, Sunil
AU - Livadas, Sarantis and
AU - Fevrier-Paul, Adwalia
AU - Wekesa, Clara
AU - Kilic, Ismail Dogu and
AU - Chaurasia, Amit Kumar
AU - Sadeq, Mina
AU - Muscatiello, Nicola
JO - Digestive Diseases and Sciences
PY - 2018
VL - 63
TODO - 7
SP - 1737-1746
PB - Springer-Verlag
SN - 0163-2116, 1573-2568
TODO - 10.1007/s10620-018-5092-6
TODO - NSBB; Cirrhosis; Mortality; Hazard ratio
TODO - 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.
ER -