1007
NONSELECTIVE BETA BLOCKERS ARE BENEFICIAL IN PATIENTS WITH CIRRHOTIC ASCITES, AND NOT DELETERIOUS WITH SPONTANEOUS BACTERIAL PERITONITIS
Date
May 21, 2024
BACKGROUND
There are controversial studies regarding the use of nonselective beta blockers (NSBB) in patients with cirrhosis and history of spontaneous bacterial peritonitis (SBP). We designed a study to investigate the effect of NSBB on mortality in patients with cirrhotic ascites and history of SBP.
METHODS
We used TRNETX to identify patients aged between 50 years to 80 years, with a diagnosis of cirrhosis, ascites, and SBP using appropriate ICD 9 and 10 codes. The data was collected from November, 2000 to November, 2023. Patients were primarily divided into two groups: SBP + NNSB [ liver cirrhosis patients with ascites and SBP that were on NSBB such as carvedilol, nadolol and propranolol] and SBP-NSBB (liver cirrhosis patients with ascites and SBP that were not on NSBB). The primary outcome was death, and the secondary outcome was AKI. Outcomes were measured for three years. We also evaluated the association of NSBB use and mortality in patients with cirrhotic ascites by creating two separate cohorts: patients with cirrhotic ascites on NSBB (Ascites+ NSBB) and patients with cirrhotic ascites not on NSBB (Ascites – NSBB). The outcomes were measured after a 1:1 propensity matching of the groups based on baseline demographics and co-morbidities.
RESULTS
A total of 12,397 & 10,047 patients were identified in the SBP-NSBB cohort) and SBP+NSB cohort respectively, prior to propensity score matching. After propensity matching, each group had 8,372 patients. There was no significant difference in mortality between the two groups [OR 0.98 (95% CI 0.91- 1.05)]. AKI was higher in the SBP+ NSB groups [OR 0.89 (95% CI 0.80- 0.99)] group.
In the Ascites + NSBB versus the Ascites - NSBB group, higher mortality was observed in patients not on NSBB compared to the Ascites+ NSBB group. [OR 1.05 (95% CI 1.02- 1.09)]. Kaplan Meier survival analysis and Hazard ratio are displayed in graph shown below.
CONCLUSION
In extensive cohorts matched for propensity, there was no statistically significant difference in mortality in individuals with cirrhotic ascites and SBP with the use of NSBB. There was, in fact, a decreased mortality in patients with cirrhotic ascites on NSBB therapy compared to the cohort not on NSBB therapy.
There are controversial studies regarding the use of nonselective beta blockers (NSBB) in patients with cirrhosis and history of spontaneous bacterial peritonitis (SBP). We designed a study to investigate the effect of NSBB on mortality in patients with cirrhotic ascites and history of SBP.
METHODS
We used TRNETX to identify patients aged between 50 years to 80 years, with a diagnosis of cirrhosis, ascites, and SBP using appropriate ICD 9 and 10 codes. The data was collected from November, 2000 to November, 2023. Patients were primarily divided into two groups: SBP + NNSB [ liver cirrhosis patients with ascites and SBP that were on NSBB such as carvedilol, nadolol and propranolol] and SBP-NSBB (liver cirrhosis patients with ascites and SBP that were not on NSBB). The primary outcome was death, and the secondary outcome was AKI. Outcomes were measured for three years. We also evaluated the association of NSBB use and mortality in patients with cirrhotic ascites by creating two separate cohorts: patients with cirrhotic ascites on NSBB (Ascites+ NSBB) and patients with cirrhotic ascites not on NSBB (Ascites – NSBB). The outcomes were measured after a 1:1 propensity matching of the groups based on baseline demographics and co-morbidities.
RESULTS
A total of 12,397 & 10,047 patients were identified in the SBP-NSBB cohort) and SBP+NSB cohort respectively, prior to propensity score matching. After propensity matching, each group had 8,372 patients. There was no significant difference in mortality between the two groups [OR 0.98 (95% CI 0.91- 1.05)]. AKI was higher in the SBP+ NSB groups [OR 0.89 (95% CI 0.80- 0.99)] group.
In the Ascites + NSBB versus the Ascites - NSBB group, higher mortality was observed in patients not on NSBB compared to the Ascites+ NSBB group. [OR 1.05 (95% CI 1.02- 1.09)]. Kaplan Meier survival analysis and Hazard ratio are displayed in graph shown below.
CONCLUSION
In extensive cohorts matched for propensity, there was no statistically significant difference in mortality in individuals with cirrhotic ascites and SBP with the use of NSBB. There was, in fact, a decreased mortality in patients with cirrhotic ascites on NSBB therapy compared to the cohort not on NSBB therapy.
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