Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Mandorfer, M; Bota, S; Schwabl, P; Bucsics, T; Pfisterer, N; Kruzik, M; Hagmann, M; Blacky, A; Ferlitsch, A; Sieghart, W; Trauner, M; Peck-Radosavljevic, M; Reiberger, T.
Nonselective β blockers increase risk for hepatorenal syndrome and death in patients with cirrhosis and spontaneous bacterial peritonitis.
Gastroenterology. 2014; 146(7): 1680-1690.
Doi: 10.1053/j.gastro.2014.03.005
Web of Science
PubMed
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- Co-Autor*innen der Med Uni Graz
- Trauner Michael
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- Abstract:
- Nonselective β blockers (NSBBs) reduce portal pressure and the risk for variceal hemorrhage in patients with cirrhosis. However, development of spontaneous bacterial peritonitis (SBP) in these patients could preclude treatment with NSBBs because of their effects on the circulatory reserve. We investigated the effects of NSBBs in patients with cirrhosis and ascites with and without SBP. We performed a retrospective analysis of data from 607 consecutive patients with cirrhosis who had their first paracentesis at the Medical University of Vienna from 2006 through 2011. Cox models were calculated to investigate the effect of NSBBs on transplant-free survival time and adjusted for Child-Pugh stage and presence of varices. NSBBs increased transplant-free survival in patients without SBP (hazard ratio = 0.75; 95% confidence interval: 0.581-0.968; P = .027) and reduced days of nonelective hospitalization (19.4 days/year for patients on NSBBs vs 23.9 days/year for patients not taking NSBBs). NSBBs had only moderate effects on systemic hemodynamics at patients' first paracentesis. However, at the first diagnosis of SBP, the proportion of hemodynamically compromised patients with systolic arterial pressure <100 mm Hg was higher among those who received NSBBs (38% vs 18% of those not taking NSBBs; P = .002), as was the proportion of patients with arterial pressure <82 mm Hg (64% of those taking NSBBs vs 44% of those not taking NSBBs; P = .006). Among patients with SBP, NSBBs reduced transplant-free survival (hazard ratio = 1.58; 95% confidence interval: 1.098-2.274; P = .014) and increased days of nonelective hospitalization (29.6 days/person-year in patients on NSBBs vs 23.7 days/person-year in those not taking NSBBs). A higher proportion of patients on NSBBs had hepatorenal syndrome (24% vs 11% in those not taking NSBBs; P = .027) and grade C acute kidney injury (20% vs 8% for those not taking NSBBs; P = .021). Among patients with cirrhosis and SBP, NSBBs increase the proportion who are hemodynamically compromised, time of hospitalization, and risks for hepatorenal syndrome and acute kidney injury. They also reduce transplant-free survival. Patients with cirrhosis and SBP should not receive NSBBs. Copyright © 2014 AGA Institute. Published by Elsevier Inc. All rights reserved.
- Find related publications in this database (using NLM MeSH Indexing)
- Acute Kidney Injury - etiology Acute Kidney Injury - mortality
- Adrenergic beta-Antagonists - adverse effects
- Aged -
- Aged -
- Chi-Square Distribution -
- Disease-Free Survival -
- Female -
- Hemodynamics - drug effects
- Hepatorenal Syndrome - diagnosis Hepatorenal Syndrome - etiology Hepatorenal Syndrome - mortality Hepatorenal Syndrome - physiopathology
- Humans -
- Hypertension, Portal - diagnosis Hypertension, Portal - drug therapy Hypertension, Portal - etiology Hypertension, Portal - mortality Hypertension, Portal - physiopathology
- Kaplan-Meier Estimate -
- Length of Stay -
- Liver Cirrhosis - complications Liver Cirrhosis - diagnosis Liver Cirrhosis - drug therapy Liver Cirrhosis - mortality Liver Cirrhosis - physiopathology
- Liver Transplantation -
- Male -
- Middle Aged -
- Paracentesis -
- Peritonitis - complications Peritonitis - diagnosis Peritonitis - microbiology Peritonitis - mortality Peritonitis - physiopathology
- Proportional Hazards Models -
- Retrospective Studies -
- Risk Factors -
- Time Factors -
- Treatment Outcome -
- Find related publications in this database (Keywords)
- Liver Fibrosis
- Bacterial Infection
- Mortality
- beta Blocker
- Adrenergic Receptor