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Nonselective ß blockers increase mortality risk in patients with cirrhosis and spontaneous bacterial peritonitis

Nonselective ß blockers increase risk for hepatorenal syndrome and death in patients with cirrhosis and spontaneous bacterial peritonitis, reports the most recent issue of Gastroenterology.

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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.

Dr Thomas Reiberger and colleagus from Austria investigated the effects of NSBBs in patients with cirrhosis and ascites with and without SBP.

The team 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.

The team found that NSBBs increased transplant-free survival in patients without SBP, and reduced days of nonelective hospitalization.

The researchers found that 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, as was the proportion of patients with arterial pressure <82 mm Hg.

Among patients with SBP, NSBBs reduced transplant-free survival, and increased days of nonelective hospitalization.

The team observed a higher proportion of patients on NSBBs had hepatorenal syndrome, and grade C acute kidney injury.

Dr Reiberger's team concludes, "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."

Gastroenterology 2014: 146(7): 1680–1690.e1
05 June 2014

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