Non-selective beta-blockers increase overall and liver mortality in alcoholic cirrhosis with MELD ≥ 12 over 5 years of follow-up.

ABSTRACT

BACKGROUND & AIMS: Non-cardioselective beta-blocker (NSBB) effects on mortality in cirrhosis are controversial. We evaluated the impact of NSBBs on mortality according to liver severity and mortality cause. METHODS: Two hundred and fifty-eight patients with alcoholic cirrhosis were included in a retroprospective cohort 129 NSBB-treated and 129 controls. The NSBB group had the following significant baseline differences higher MELD, more frequent previous gastrointestinal bleeding, large oesophageal varices (OV) and lower heart rate. Propranolol dose was 160 mg/d in 81% of NSBB patients. RESULTS: (i) Liver function during 5.3 ± 2.6 years of follow-up, MELD progression was higher in NSBB patients 1 (-1-4) than in controls 0 (-1-1) (P = .017). (ii) Overall survival no significant differences were observed between NSBBs and controls (Kaplan-Meier curves P = .291). In multivariate Cox analysis, baseline MELD interacted with NSBB (P = .011). Thus, the NSBB hazard ratio (HR) was 0.99 (0.50-1.98) in MELD < 12 vs 3.17 (1.19-8.42) in MELD ≥ 12. (iii) Liver survival NSBB decreased liver survival (Kaplan-Meier P = .031). In multivariate Cox analysis, baseline MELD interacted with NSBB (P < .001). The NSBB HR was 0.81 (0.30-2.19) in MELD < 12 vs 6.23 (1.94-20.0) in MELD ≥ 12. In competing risk multivariate analysis for liver mortality, the MELD-NSBB interaction was significant (P < .001) the NSBB HR was 1.02 (0.36-2.91) in MELD < 12 vs 9.24 (3.18-26.9) in MELD ≥ 12. 4) Non-liver survival contrastingly, non-liver survival was increased by NSBBs, especially in MELD ≥ 12 (competing Kaplan-Meier P = .044). These results were confirmed in propensity risk score (PRS)-matched patients. CONCLUSION: In alcoholic cirrhosis with rather high propranolol doses, overall and liver survival are significantly aggravated when MELD is ≥12.