Beta-blocker therapy confers survival benefit in viral hepatitis-related cirrhosis

Among patients with viral hepatitis-related cirrhosis who sustained non-bleeding decompensating events, the use of non-selective beta blockers is associated with lower mortality, as shown in a study.

Researchers conducted an emulated target trial using the Korean National Health Insurance Service database. They identified 7,725 patients with viral hepatitis-related cirrhosis hospitalized for hepatic encephalopathy, hepatorenal syndrome, ascites, and/or spontaneous bacterial peritonitis. Of these patients, 2,455 were beta-blocker users and 5,270 were nonusers.

All-cause death within 6 months was the primary outcome.

Compared with nonusers, those receiving beta-blocker therapy had a 28-percent lower risk of all-cause death within 6 months (hazard ratio [HR], 0.82, 95 percent confidence interval [CI], 0.68–0.97). The cumulative incidence of mortality was 7.8 percent among beta-blocker users vs 11 percent among nonusers.

The reduced risk of all-cause death with beta-blocker therapy was consistently observed across complication types and patient subgroups.

When analysed by dose and agent, lower mortality was observed for low-dose beta blockers (HR, 0.75, 95 percent CI, 0.59–0.94) and for carvedilol (HR, 0.55, 95 percent CI, 0.32–0.94) relative to nonuse. There were no significant associations for moderate-to-high-dose therapy (HR, 0.90, 95 percent CI, 0.71–1.15) and propranolol (HR, 0.87, 95 percent CI, 0.72–1.04).