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Nonselective beta blockers improve short-term survival for ACLF

Treating patients with cirrhosis with nonselective beta blockers was safe and improved 28-day survival if diagnosed with acute-on-chronic liver failure, according to study data.

In a prospective study, researchers evaluated 349 patients with acute-on-chronic liver failure (ACLF) enrolled in the CANONIC study, which is a study investigating acute decompensation among 1,349 patients with cirrhosis from 29 European hospitals. The present analysis focused on the ACLF cohort, so all clinical data pertaining to the use of nonselective beta blockers (NSBBs), their type and dosage were recorded and studied.

“The specific aims of this study were to evaluate the clinical effects of ongoing administration of NSBBs in hospitalized cirrhotic patients who developed ACLF focusing on safety of its use, effects on organ function and mortality, clinical course of ACLF and effects on inflammatory markers,” the researchers wrote.

Overall, 47% of all patients with ACLF received NSBBs (n = 164). A greater number of patients in the NSBB-treated group had lower grades of ACLF compared with patients in the untreated group (P = .047), despite CLIF-Consortium ACLF scores being similar between the two groups at baseline. The grade of ACLF greatly improved over time in the NSBB-treated patients compared with the untreated patients.

Overall, the untreated patients had a higher short-term mortality rate and lower probability of survival compared with the patients treated with NSBBs. A total of 40 patients died who had been treated with NSBBs compared with 63 patients in the untreated group (risk-reduction ratio = 0.596; 95% CI, 0.361-0.985). Greater survival in the NSBB-treated patients was associated with a lower white cell count in this group (8.5) compared with untreated patients (10.8; P = .002). However, 6-month mortality rates (NSBB: 47.6% vs. no NSBB: 49.7%; P = .64) and 1-year mortality rates (NSBB: 51.8% vs. no NSBB: 56.8%; P = .35) were similar between the groups.

“The results of this study show for the first time that in patients with cirrhosis presenting with ACLF, NSBBs were safe to administer and its use was independently associated with improved 28-day survival,” the researchers wrote.

“NSBBs provide a safe, cheap and effective therapy for patients with cirrhosis and until more prospective data are available, careful thought should be given to stopping this drug as it reduces mortality if patients go on to develop ACLF,” the researchers concluded. – by Melinda Stevens

Disclosures: Mookerjee reports no relevant financial disclosures. Please see the study for a full list of all other authors’ relevant financial disclosures.