beta-Blockers protect against spontaneous bacterial peritonitis in cirrhotic patients: a meta-analysis.
BACKGROUND
Bacterial infections have been hypothetized to be a trigger of variceal bleeding in cirrhotic patients and beta-blockers may have a protective effect by decreasing bacterial translocation, reducing portal pressure. The aim of our study was to evaluate the possible role of beta-blockers in preventing spontaneous bacterial peritonitis (SBP) in patients with liver cirrhosis and ascites.


METHODS
Extensive search of the literature including randomized controlled trial (RCT) and non-RCT of primary and secondary prophylaxis for variceal bleeding in cirrhotics using beta-blockers were evaluated. We performed a meta-analysis using the occurrence of SBP as endpoint in all the studies, using the random effect model.


RESULTS
Three RCT and three retrospective studies in which beta-blockers were evaluated against no treatment for the prevention of SBP in ascitic cirrhotics were included. There was a statistically significant difference of 12.1%, P<0.001 in favour of propranolol in preventing SBP, which was confirmed by sensitivity analysis evaluating only RCTs (7.8% difference). The effect was still present when haemodynamic responders were compared with non-responders.


CONCLUSIONS
This analysis suggests a role of beta-blockers in preventing SBP in ascitic cirrhotics, independent of haemodynamic response. Further formal RCTs are needed to confirm this finding.
Senzolo
Marco
M
The Royal Free Sheila Sherlock Liver Centre, Department of Surgery, London, UK.
Cholongitas
Evangelos
E
Burra
Patrizia
P
Leandro
Gioacchino
G
Thalheimer
Ulrich
U
Patch
David
D
Burroughs
Andrew Kenneth
AK
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000209:etiology / Q000517:prevention & control*; D018988:Bacterial Translocation / Q000187:drug effects; D016206:Databases, Bibliographic; D004932:Esophageal and Gastric Varices / Q000188:drug therapy / Q000209:etiology; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000188:drug therapy*; D010538:Peritonitis / Q000382:microbiology / Q000517:prevention & control*; D011433:Propranolol / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic
D000319:Adrenergic beta-Antagonists; D011433:Propranolol