This article is more than 5 years old. Information may no longer be current.
No link between serious infections, nonselective beta blockers among cirrhosis patients
Patients with cirrhosis treated with nonselective beta blockers are no more likely than nonusers to develop serious infections, according to recent results.
In a retrospective cohort study, researchers evaluated 12,656 patients with compensated and 4,834 patients with decompensated cirrhosis. Data on all participants was collected from the US Veterans Health Administration between 2001 and 2009. In each group, new users of nonselective beta-blockers (NSBBs), as indicated by the VA Pharmacy Benefits Management database, were matched with nonusers (n=1,836, compensated group; n=1,462, decompensated group), and incidence of serious infection, transplantation and death was observed and compared between groups.
Among those with compensated cirrhosis in the matched cohort, 0.2% of patients died and 0.5% received liver transplantation (median follow-up, 1,191 days). Death occurred in 1.1% and transplantation in 1.6% of those in the matched decompensated group (median follow-up, 1,124 days), with both events occurring earlier among NSBB users compared with nonusers (P=.0086 for transplantation; P=.0061 for death).
Serious infection was the leading cause for hospitalization in both groups, and occurred more frequently among decompensated patients (471 patients vs. 152 compensated patients).
No significant difference was observed in the incidence of infection according to NSBB use in either group, with adjusted HRs of 0.9 (95% CI, 0.59-1.36) for all patients with compensated cirrhosis and 1.1 (95% CI, 0.96-1.25) for those with decompensated cirrhosis. Similar results were observed in analysis of the two matched cohorts.
Jasmohan S. Bajaj
“NSBBs can be used as recommended in the guidelines for variceal hemorrhage prophylaxis without undue concerns about increasing the risk of infections in compensated or decompensated cirrhosis,” researcher Jasmohan S. Bajaj, MD, MS, associate professor in the gastroenterology, hepatology and nutrition division of Virginia Commonwealth University in Richmond, Va., told Healio.com. “Clinicians may be interested in the effects that concomitant medications might have in promoting or protecting cirrhotic patients from infections, which remain the most important determinant of survival in the current milieu. Before initiating any new medications, the risk-benefit ratio and appropriate duration of therapy should be considered.”