title: The Beneficial Effect of Beta-Blockers in Patients With Cirrhosis, Portal Hypertension and Ascites.
abstract: BACKGROUND
  Patients with cirrhosis and portal hypertensive complications have reduced survival. As such, it has been suggested that nonselective beta-blocker therapy in patients with advanced ascites is harmful. The aim of this study was, therefore, to determine the risk of mortality in patients with cirrhosis and ascites taking nonselective beta-blocker therapy for the prevention of variceal hemorrhage.
  
  
  METHODS
  This study was a retrospective analysis of 2,419 patients with cirrhosis and portal hypertension admitted to Parkland Memorial Hospital (a university-affiliated county teaching hospital) from 2003-2010. Patients were subdivided into those with varices only, ascites only and those with both varices and ascites. The primary outcome measure for this study was all-cause in-hospital mortality.
  
  
  RESULTS
  Overall, 68 of 1,039 (6.5%) patients taking beta-blockers died during their hospitalization, while 223 of 1,380 (16.2%) patients not taking beta-blockers died (P < 0.001). Beta-blocker use was also assessed in specific cohorts; mortality was 21.1% in patients with severe ascites with varices who were not taking beta-blockers compared with 8.9% in patients who were taking beta-blockers (P = 0.05). Overall, fewer patients taking beta-blockers died compared with those not taking beta-blockers in patients with varices only (6.4% versus 12.1%) and those with ascites with or without varices (6.6% versus 18.1%) (P < 0.001).
  
  
  CONCLUSIONS
  Mortality was lower in patients with cirrhosis and portal hypertension taking nonselective beta-blockers than in those not taking beta-blockers. The use of nonselective beta-blockers provided a significant survival benefit in patients with all grades of ascites, including those with severe ascites.
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center, Parkland Memorial Hospital, Parkland Health and Hospital System, Dallas, Texas.
authors.forename: Ariel W
authors.initials: AW
authors.lastname: Aday
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center, Parkland Memorial Hospital, Parkland Health and Hospital System, Dallas, Texas.
authors.forename: Marlyn J
authors.initials: MJ
authors.lastname: Mayo
authors.affiliation: Department of Statistical Science, Southern Methodist University, Dallas, Texas.
authors.forename: Alan
authors.initials: A
authors.lastname: Elliott
authors.affiliation: Department of Internal Medicine, Medical University of South Carolina, Charleston, South Carolina. Electronic address: rockey@musc.edu.
authors.forename: Don C
authors.initials: DC
authors.lastname: Rockey
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D001201:Ascites / Q000188:drug therapy / Q000401:mortality*; D005260:Female; D005355:Fibrosis / Q000188:drug therapy / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D006975:Hypertension, Portal / Q000188:drug therapy / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D013781:Texas / Q000453:epidemiology; D014648:Varicose Veins / Q000188:drug therapy / Q000401:mortality
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: Mortality; Nadolol; Nonselective; Propranolol; Varices