Non-selective beta-blocker use in cirrhosis: the additional benefit in preventing secondary infections

On binary logistic regression; factors independently associated with 1-year survival were NSBB use (OR 5.18, 95% CI 1.67 to 16.01, p=0.004), lower baseline Model For End-Stage Liver Disease score (OR 1.25, 95% CI 1.11 to 1.41, p=0.0001) and lower infection rates (OR 1.72, 95% CI 1.17 to 2.58, p=0.007).Table 1 Baseline characteristics of NSBB users and non-users attending a specialist cirrhosis clinic at St Mary’s Hospital, London, UK Demographics NSBB (n=89) Non-NSBB (n=49) P value Sex (%) 0.39 Male 64 (71.9) 31 (63.3) Female 25 (28.1) 18 (36.7) Age (years) (IQR) 58 (49–66) 59 (52–67) 0.47 Main aetiology (%) 0.52 Alcohol 48 (53.9) 31 (63.3) Hepatitis C 16 (18.0) 7 (14.3) Non-alcoholic steatohepatitis 6 (6.7) 6 (12.2) Disease severity (IQR) Child-Pugh Score 8 (8–10) 8 (7–10) 0.39 Model For End-Stage Liver Disease score 13.50 (11.40–15.80) 11.80 (9.40–14.40) 0.006 Ascites (%) None 38 (42.7) 17 (34.7) 0.12 Mild 24 (27.0) 9 (18.4) Moderate 18 (20.2) 11 (22.4) Severe 9 (10.1) 12 (24.5) Hepatic encephalopathy (%) 24 (27.0) 10 (20.4) 0.52 Hepatocellular carcinoma (%) 6 (6.7) 1 (2.0) 0.42 Laboratory parameters (IQR) Sodium (mmol/L) 137 (133–139) 137 (135–138) 0.91 Creatinine (μmol/L) 70 (62–84) 63 (57–73) 0.03 Albumin (g/L) 29 (25–33) 30 (26–33) 0.33 Bilirubin (µmol/L) 39 (23–59) 30 (15–52) 0.06 International normalised ratio 1.3 (1.2–1.5) 1.3 (1.2–1.4) 0.03 Platelets (×109/L) 96 (66–144) 127 (83–136) 0.03 NSBB, non-selective beta blocker. [...]we agree with Jachs et al that in clinical trials involving cirrhotic patients, where inflammatory/infective outcome measures are being assessed, consideration needs to be given to patient stratification by NSBB use to allow optimal study design and interpretation of results. [...]infections independently increase mortality in hospitalized patients with cirrhosis: the North American Consortium for the study of end-stage liver disease (NACSELD) experience.