Non-Selective Beta-Blockers Decrease Infection, Acute Kidney Injury Episodes, and Ameliorate Sarcopenic Changes in Patients with Cirrhosis: A Propensity-Score Matching Tertiary-Center Cohort Study

Abstract

Background: Cirrhotic complications resulting from portal hypertension can be considerably reduced by non-selective beta-blockers (NSBBs); however, scarce studies have investigated therapeutic agents for other complications. We aimed to investigate the effects of NSBBs on common cirrhotic complications of infection, acute kidney injury (AKI), chronic renal function declination, and sarcopenic changes. Methods: Medical records of hospitalization for cirrhosis with at least a 4-year follow-up were analyzed and selected using propensity-score matching (PSM). Generalized estimating equation (GEE) was applied to assess the association of NSBBs with infection requiring hospitalization and AKI. Chronic renal function declination was evaluated by slope of regression lines derived from reciprocal of the serum creatinine level. The covariates of CT-measured skeletal muscle index (SMI) alterations were analyzed by generalized linear mixed model. Results: Among the 4946 reviewed individuals, 166 (83 NSBB group, 83 non-NSBB group) were eligible. Using GEE, Charlson comorbidity index, Child-Pugh score and non-NSBB were risk factors for infection; non-NSBB group revealed a robust trend toward AKI, showed no significant difference with chronic renal function declination of NSBB group, and was negatively associated with SMI alteration. Conclusion: Chronic NSBB use lowered the episodes of infection requiring hospitalization and AKIs, whereas non-NSBB was associated with sarcopenic changes.

Non-Selective Beta-Blockers in Patients with Cirrhosis: Current Evidence and Controversy

“…However, Li et al showed that the administration of NSBBs may reduce the occurrence of AKI and marginally alleviate chronic renal function declination [52]. Maiwall et al observed consecutive cirrhotic patients with a complete record of baseline hemodynamics.…”

Portal Hypertension in Malnutrition and Sarcopenia in Decompensated Cirrhosis—Pathogenesis, Implications and Therapeutic Opportunities

“…A retrospective study by Li et al compared 20 cirrhotic patients treated with NSBBs with 20 propensity-score matched cirrhotic patients not on NSBBs who had abdominal CTs after 4 years of follow up. The cirrhotic patients who did not receive NSBBs had a significantly reduced skeletal muscle index at 4 years (mean SMI alteration −1.782 ± 4.624 cm 2 /m 2 ) compared with patients who did receive NSBBs (mean alteration 1.195 ± 5.633 cm 2 /m 2 ) [ 139 ]. Further, ideally, prospective studies are needed to clarify the effect of NSBBs on malnutrition and sarcopenia in patients with cirrhosis and portal hypertension.…”

Nutritional assessment in patients with liver cirrhosis

“…Beta blockers have been suggested as a possible external factor contributing to malnutrition in cirrhosis. However, a recent study found that patients who received non-selective beta blockers had actually better skeletal muscle index and improvement in sarcopenia[ 22 ].…”