title: The use of beta-blockers is associated with the occurrence of acute kidney injury in severe alcoholic hepatitis.
abstract: OBJECTIVE
  The beneficial effect of nonselective beta-blockers (NSBB) has recently been questioned in patients with end-stage cirrhosis. We analysed the impact of NSBB on outcomes in severe alcoholic hepatitis (AH).
  
  
  METHODS
  This study was based on a prospective database of patients with severe, biopsy-proven AH. Patients admitted from July, 2006 to July, 2014 were retrospectively studied. Patients were divided into two groups (with and without NSBB) and assessed for the occurrence of Acute Kidney Injury (AKI) and transplant-free mortality during a 168-day follow-up period.
  
  
  RESULTS
  One hundred thirty-nine patients were included, the mean Maddrey score was 71 ± 34 and 86 patients (61.9%) developed AKI. Forty-eight patients (34.5%) received NSBB. The overall 168-day transplant-free mortality was 50.5% (95%CI, 41.3-60.0%). The overall 168-day cumulative incidence of AKI was 61.9% (95%CI, 53.2-69.4%). When compared, patients with NSBB had a lower heart rate (65 ± 13 vs 92 ± 12, P < 0.0001) and a lower mean arterial pressure (MAP, 78 ± 3 vs 87 ± 5, P < 0.0001). Patients with NSBB had comparable MELD scores, Maddrey scores, and medical histories. The 168-day transplant-free mortality was 56.8% (95%CI, 41.3-69.7%) in patients with NSBB and 46.7% (95%CI, 35.0-57.6%) without NSBB (P = 0.25). The 168-day cumulative incidence of AKI was 89.6% (95%CI, 74.9-95.9%) with NSBB compared to 50.4% (95%CI: 39.0-60.7) for no NSBB (P = 0.0001). The independent factors predicting AKI were a higher MELD score and the presence of NSBB.
  
  
  CONCLUSIONS
  The use of NSBB in patients with severe AH is independently associated with a higher cumulative incidence of AKI.
authors.affiliation: Liver Unit, Department of Gastroenterology and Hepatopancreatology, CUB Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium.|Department of Hepatogastroenterology, CHU Saint-Pierre, Bruxelles, Belgium.
authors.forename: Thomas
authors.initials: T
authors.lastname: Sersté
authors.affiliation: Biomedical Statistics, Université Libre de Bruxelles, Bruxelles, Belgium.
authors.forename: Hassane
authors.initials: H
authors.lastname: Njimi
authors.affiliation: Liver Unit, Department of Gastroenterology and Hepatopancreatology, CUB Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium.
authors.forename: Delphine
authors.initials: D
authors.lastname: Degré
authors.affiliation: Service de Gastroentérologie et d'Hépatologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Pierre
authors.initials: P
authors.lastname: Deltenre
authors.affiliation: Liver Unit, Department of Gastroenterology and Hepatopancreatology, CUB Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium.
authors.forename: Jonas
authors.initials: J
authors.lastname: Schreiber
authors.affiliation: Liver Unit, Department of Gastroenterology and Hepatopancreatology, CUB Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium.
authors.forename: Antonia
authors.initials: A
authors.lastname: Lepida
authors.affiliation: Liver Unit, Department of Gastroenterology and Hepatopancreatology, CUB Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium.|Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, Bruxelles, Belgium.
authors.forename: Eric
authors.initials: E
authors.lastname: Trépo
authors.affiliation: Liver Unit, Department of Gastroenterology and Hepatopancreatology, CUB Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium.|Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, Bruxelles, Belgium.
authors.forename: Thierry
authors.initials: T
authors.lastname: Gustot
authors.affiliation: Liver Unit, Department of Gastroenterology and Hepatopancreatology, CUB Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium.|Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, Bruxelles, Belgium.
authors.forename: Christophe
authors.initials: C
authors.lastname: Moreno
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000453:epidemiology* / Q000473:pathology; D000319:Adrenergic beta-Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D000704:Analysis of Variance; D001707:Biopsy, Needle; D002423:Cause of Death; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006519:Hepatitis, Alcoholic / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: acute kidney injury; alcoholic hepatitis; beta-blockers; cirrhosis