Studies on the beneficial or deleterious effect of NSBBs on advanced cirrhosis
| Author, year, Ref | Design (n) | End point | Characteristics (RA) | Presence of oesophageal varices non-BB vs BB | CPT-C non-BB vs BB (%) | MAP non-BB vs BB | Doses BB | Follow-up (month) | HR | Other outcomes |
|---|---|---|---|---|---|---|---|---|---|---|
| Sertsé et al 201052 | Observational Prospective, 151 | Long-term survival | RA (100%) | 4% vs 100% | 61% vs 74% | 123 vs 103 | 114 mg/day | 8 m | HR 2.61 (1.63 to 4.19) | 1-year probability survival propranolol 19%vs 64% p <0.0001 |
| Mandorfer et al 201470 | Observational Retrospective, 607 (182 SBP) | Impact of SBP on BB on survival | SBP (NS) | 60% vs 94% | 53% vs 67% | 83 vs 77 | NS | 9.6 (147 person year) | HR 1.64 (1.1 to 2.3) | Patients with SBP on BB increase in mortality risk of 58% |
| Leithead et al 201571 | Observational Retrospective, 322 (208 matched) | Mortality | Ascites on transplant list (117 (76 matched, 36.5%)) | Previous variceal haemorrhage 29% vs 29% | NS | 89 vs 86 | 74.8% P (80 mg/day) 25.2% C (6.25 mg/day) | 2.4 (72 days) | HR 0.55 (0.32 to 0.95) RA: HR 0.35 (0.14 to 0.86) | Mortality after listing 23.2% BB vs 34.8% no-BB |
| Bossen et al 201575 | Post hoc Analysis of 3 RCT, 1188 | Mortality or hospitalisation | Ascites in RCT of satavaptan/placebo 588 (49%) 559 BB users (46%) | Previous variceal haemorrhage 13% vs 30% | 28% vs 24% | 85 vs 83 | 159 high dose (>80 mg/day) P or >6.25 mg/day C | 12 (52 weeks) | 0.92 (0.72 to 1.18) RA: 1.02 (0.74 to 1.40) | HR high dose vs no-BB users 0.8 (0.55 to 1.20) HR low dose vs no-BB users 0.98 (0.72 to 1.13) |
| Mookerjee et al 201631 | Observational prospective, 349 | Mortality at 28 days | ACLF (NS) | NS. Previous gastrointestinal bleeding 17% vs 58% | NS | 79 vs 78 | 40 mg/day (68%) | 12 (56 weeks) | 0.60 (0.36 to 0.98) | 1-year mortality NSBB vs no-NSBB 52% vs 56% p=0.35 |
| Gianelli et al 201682 | Observational, retrospective 526 | Cirrhotic cardiomyopathy | Transplant waitlist (NS) | NS | NS | NS | NS | NS | NS | Systolic dysfunction was higher in MELD>25 with BB, and similar in MELD<25 regardless BB |
| Aday et al 201672 | Retrospective, 2419 Propensity matching score on | In-hospital mortality | Portal hypertension (100%) | 51% vs 49% | Severe ascites no BB 62% vs 37% on BB | NS | NS | NS | NS | The highest mortality was among those with cirrhosis and severe ascites no-BB (23.2%, compared with 6.5% BB) |
| Robins et al 201474 | Observational retrospective, 114 | Survival | Cirrhosis undergoing elective paracentesis (100%) | 54% vs 100% | 64% vs 64% | NS. | 48.9 mg/day | Median 10 (2–72) | NS | Median survival BB vs no-BB 18 vs 11 months p=0.93 |
| Kim et al 201468 | Nested case–control, 2250 | Association BB-AKI | RA on transplant list (NS) | NS | NS | NS | NS | Median 20.3 (3–201) | NS | |
| Bhutta et al 201676 | Prospective analysis, 717 | Survival | Ascites | 17% vs 31% | NS | NS | NS | NS | NS | Survival 58 days in BB vs 32 days n-BB |
| Chirapongsathorn et al 201623 | Meta-analysis 3 RCT and 8 observational studies, 3145 | Mortality | Ascites 443 (14%) | NS | NS | NS | NS | NS | RR: 0.95 (0.67 to 1.35) RA: 0.95 (0.57 to 1.61). | Mortality rate 6 months BB vs no-BB 52% vs 42.5% RR 1.37 (0.94 to 1.98) |
| Kalambokis et al 201667 | Observational retrospective, 171 | Mortality | Ascites | NS | NS | NS | NS | 3 years | NS | Median survival |
| Kimer et al 201573 | Retrospective cohort, 61 | In-hospital mortality | Ascites | 31% vs 82%* | NS | NS | Median 80 mg/day | ∼3.5 years | NS | No difference in survival. Complications 76% no-BB vs 78% BB |
*Thirty-seven per cent of patients in non-BB group and 13% in the BB group were not characterised with oesophageal endoscopy.
ACLF, acute-on-chronic liver failure; AKI, acute kidney injury; BB, β-blockers; C, carvedilol; CP, Child-Pugh Class; CPT, Child-Push Turcotte; MAP, mean arterial pressure; MELD, Model for End-stage Liver Disease; NS, not stated; NSBB, non-selective β-blocker; P, propranolol; RA, refractory ascites; RCT, randomised controlled trial; RR, relative risk; SBP, spontaneous bacterial peritonitis.