Deleterious effects of beta-blockers on survival in patients with cirrhosis and refractory ascites.
Beta-blockers may have a negative impact on survival in patients with cirrhosis and refractory ascites. The aim of this study was to evaluate the effect of the administration of beta-blockers on long-term survival in patients with cirrhosis and refractory ascites. We performed a single-center, observational, case-only, prospective study of patients with cirrhosis and refractory ascites who did or did not receive beta-blockers for the prevention of gastrointestinal bleeding; 151 patients were included. The mean Model for End-Stage Liver Disease score was 18.8 +/- 4.1. All patients regularly underwent large-volume paracentesis and intravenous albumin administration. Seventy-seven patients (51%) were treated with propranolol (113 +/- 46 mg/day). The median follow-up for the whole group was 8 months. The median survival time was 10 months [95% confidence interval (CI) = 8-12 months]. The probability of survival at 1 year was 41% (95% CI = 33%-49%). The clinical characteristics and laboratory values at enrolment were not significantly different between patients who were receiving propranolol and those who were not. The median survival time was 20.0 months (95% CI = 4.8-35.2 months) in patients not treated with propranolol and 5.0 months (95% CI = 3.5-6.5 months) in those treated with propranolol (P = 0.0001). The 1-year probability of survival was significantly lower in patients who received propranolol [19% (95% CI = 9%-29%)] versus those who did not [64% (95% CI = 52%-76%), P < 0.0001]. The independent variables of mortality were Child-Pugh class C, hyponatremia and renal failure as causes of refractory ascites, and beta-blocker therapy.


CONCLUSIONS
The use of beta-blockers is associated with poor survival in patients with refractory ascites. These results suggest that beta-blockers should be contraindicated in these patients.
Sersté
Thomas
T
Institut National de la Santé et de la Recherche Médicale Unité 773, Centre de Recherche Biomédicale Bichat Beaujon, Paris, France.
Melot
Christian
C
Francoz
Claire
C
Durand
François
F
Rautou
Pierre-Emmanuel
PE
Valla
Dominique
D
Moreau
Richard
R
Lebrec
Didier
D
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D001201:Ascites / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality*; D000075202:Contraindications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007010:Hyponatremia / Q000150:complications; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000188:drug therapy* / Q000401:mortality*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011433:Propranolol / Q000627:therapeutic use; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000150:complications; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D011433:Propranolol