Original ResearchFull Report: Clinical—LiverNonselective β Blockers Increase Risk for Hepatorenal Syndrome and Death in Patients With Cirrhosis and Spontaneous Bacterial Peritonitis
Section snippets
Study Design
A total of 607 consecutive patients with cirrhosis who underwent their first paracentesis at the Medical University of Vienna between 2006 and 2011, had bacterial cultures from ascites, and did not display any exclusion criteria, were included in this retrospective study. Patients with other causes of ascites, such as severe cardiovascular disease, renal insufficiency, extrahepatic malignancies, and noncirrhotic portal hypertension, were excluded from the study.
Assessed Parameters
Epidemiological characteristics,
Patient Characteristics and Systemic Hemodynamics at the First Paracentesis
Except for a higher proportion of female subjects (NSBB: 34% vs no-NSSB: 27%; P = .048) and patients with varices (NSBB: 90% vs no-NSBB: 62%; P < .001) in the NSBB group, no statistically significant differences in patient characteristics between patients with NSBB treatment, and without, were observed (Table 1).
Although the mean heart rate (NSBB: 77.5 ± 16.5 beats/min vs no-NSBB: 83.9 ± 15.5 beats/min; P < .001) and systolic arterial pressure (SAP) (NSBB: 114 ± 18 vs no-NSBB: 117 ± 18 mm Hg; P
Discussion
A recent landmark study by Serste et al12 demonstrated reduced survival in patients with refractory ascites who were treated with NSBBs and has initiated a lively debate among gastroenterologists on the appropriate use of NSBBs in patients with advanced cirrhosis. In summary, the editorial30 and various other responses to this study brought up concerns about the unequal distribution of esophageal varices between the NSBB and no-NSBB group. In addition, the trends toward a higher prevalence of
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This article has an accompanying continuing medical education activity on page e14. Learning Objective: Upon completion of this exam, successful learners will be able to identify patients with cirrhosis and ascites that no longer benefit from non-selective β blocker treatment since the development of spontaneous bacterial peritonitis indicates an event when non-selective beta-blockers can compromise the circulatory reserve.
Conflicts of interest The authors disclose no conflicts.
Author names in bold designate shared co-first authors.