title: Non-selective beta-blockers are not associated with serious infections in veterans with cirrhosis.
abstract: BACKGROUND
  Studies evaluating outcomes associated with non-selective beta-blockers (NSBB) in cirrhosis have yielded mixed results. A major cause of death in decompensated cirrhosis is infection.
  
  
  OBJECTIVE
  To determine the effect of NSBB use on serious infections (requiring hospitalisation) in compensated and decompensated cirrhosis.
  
  
  METHODS
  Using data from the US Veterans Health Administration from 2001-2009, we identified two cohorts: compensated cirrhotics (n = 12,656) and decompensated cirrhotics (n = 4834). From each cohort, we identified new NSBB users and propensity-matched them 1:1 to non-users (n = 1836 each in compensated users/non-users and n = 1462 each in decompensated users/non-users). They were followed up for serious infections (median time: 3.1 years), death and transplant. We estimated adjusted hazard ratios (HR) and 95% confidence intervals (CI) from Cox regression models.
  
  
  RESULTS
  Death or transplantation occurred in 0.7% compensated and 2.7% of decompensated patients. Among decompensated cirrhotics, death (P = 0.0061) and transplantation (P = 0.0086) occurred earlier in NSBB users compared with non-users. Serious infections were observed in 4.8% of compensated cirrhotics and in 13.7% of decompensated cirrhotics. There was no difference in the rate of serious infection development in new NSBB users compared with non-users in the compensated (adjusted HR: 0.90, CI: 0.59-1.36) or in the decompensated group (adjusted HR: 1.10, CI: 0.96-1.25).
  
  
  CONCLUSIONS
  The use of non-selective beta-blockers in U.S. veterans is not associated with an increased rate of serious infections in compensated or decompensated cirrhosis.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire Veterans Affairs Medical Center, Richmond, VA 23249, USA. jsbajaj@vcu.edu
authors.forename: J S
authors.initials: JS
authors.lastname: Bajaj
authors.forename: S M
authors.initials: SM
authors.lastname: Ratliff
authors.forename: D M
authors.initials: DM
authors.lastname: Heuman
authors.forename: K L
authors.initials: KL
authors.lastname: Lapane
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007239:Infections / Q000453:epidemiology*; D008103:Liver Cirrhosis / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D016016:Proportional Hazards Models; D012307:Risk Factors; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data
chemical_list: D000319:Adrenergic beta-Antagonists