Use of Non-selective Beta blockers in Decompensated Cirrhosis and ACLF

Purpose of Review Our understanding of beta blockers in liver cirrhosis has transformed over the last 40 years. However, questions remain over their safety in acute decompensation and acute on chronic liver failure. Since these conditions are associated with significant morbidity and mortality, a critical appraisal of recent literature is imperative to help guide clinicians. Recent Findings The latest BAVENO guidelines now recommend carvedilol in all patients with clinically significant portal hypertension to prevent decompensation. There is significant data which shows safety of beta blocker use in decompensated cirrhosis but concerns remain in refractory ascites. There is also a short-term mortality benefit demonstrated in acute on chronic liver failure. Summary With the latest guidelines and recent evidence, it seems beta blocker use will continue to increase. Future studies should aim to identify biomarkers that can determine who will benefit from beta blockers and help guide therapy.