Nonselective Beta-Blockers Do Not Affect Survival in Cirrhotic Patients with Ascites
| Autor: | Facciorusso AAUID- ORCID: 0000-0002-2107-2156, Roy S, Livadas S, Fevrier-Paul A, Wekesa C, Kilic ID, Chaurasia AK, Sadeq M, Muscatiello N |
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| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Adrenergic beta-Antagonists/adverse effects/*therapeutic use
Ascites/*drug therapy/etiology/mortality Chi-Square Distribution Hepatorenal Syndrome/etiology/mortality Humans Incidence Kaplan-Meier Estimate Liver Cirrhosis/complications/*drug therapy/mortality Odds Ratio Peritonitis/microbiology/mortality Risk Factors Time Factors Treatment Outcome |
| Popis: | BACKGROUND: The role of nonselective beta-blockers in cirrhotic patients with ascites has been recently questioned; however, definitive evidence in this regard is still lacking. AIMS: To analyze published data on the influence of nonselective beta-blockers as compared to control group on survival of cirrhotic patients with ascites. METHODS: Computerized bibliographic search on the main databases was performed. Hazard ratios from Kaplan-Meier curves were extracted in order to perform an unbiased comparison of survival estimates. Secondary outcomes were mortality in patients with refractory ascites, pooled rate of nonselective beta-blockers interruption, spontaneous bacterial peritonitis and hepato-renal syndrome incidence. RESULTS: Three randomized controlled trials and 13 observational studies with 8279 patients were included. Overall survival was comparable between the two groups (hazard ratio = 0.86, 0.71-1.03, p = 0.11). Study design resulted as the main source of heterogeneity in sensitivity analysis and meta-regression. Mortality in refractory ascites patients was similar in the two groups (odds ratio = 0.90, 0.45-1.79; p = 0.76). No difference in spontaneous bacterial peritonitis (odds ratio = 0.78, 0.47-1.29, p = 0.33) and hepato-renal syndrome incidence (odds ratio = 1.22, 0.48-3.09; p = 0.67) was observed. Pooled rate of nonselective beta-blockers interruption was 18.6% (5.2-32.1%). CONCLUSIONS: Based on our findings, nonselective beta-blockers should not be routinely withheld in patients with cirrhosis and ascites, even if refractory. |
| Databáze: | OpenAIRE |
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