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The longitudinal outcomes of applying non-selective beta-blockers in portal hypertension: real-world multicenter study

Title
The longitudinal outcomes of applying non-selective beta-blockers in portal hypertension: real-world multicenter study
Authors
Kang S.H.Lee M.Kim M.Y.Lee J.H.Jun B.G.Kim T.S.Choi D.H.Suk K.T.Kim Y.D.Cheon G.J.Kim D.J.Baik S.K.
Ewha Authors
이민종
SCOPUS Author ID
이민종scopusscopus
Issue Date
2021
Journal Title
Hepatology International
ISSN
1936-0533JCR Link
Citation
Hepatology International vol. 15, no. 2, pp. 424 - 436
Keywords
AscitesEsophageal varixHepatic venous pressure gradientLiver cirrhosisLow-dose non-selective β-blockersNonselective β-blockersPortal hypertensionSeveritySurvivalTreatment
Publisher
Springer
Indexed
SCIE; SCOPUS WOS scopus
Document Type
Article
Abstract
Background/Aim: We investigated the effect of non-selective β-blockers (NSBB) in real-world situations and whether low-dose NSBB is beneficial compared to maximally tolerated doses. Methods: We performed a retrospective study of 740 patients with cirrhosis requiring prophylactic treatment of esophageal varices: 473 primary prophylaxis (PP: NSBB = 349, non-NSBB = 124) and 267 secondary prophylaxis (SP: NSBB = 200, non-NSBB = 67). The NSBB group was divided into low-dose (≤ 80 mg/day) and high-dose (> 80 mg/day). Results: In the PP group, NSBB treatment reduced mortality and showed the most pronounced effect in patients with moderate/severe ascites (hazard ratio [HR], 0.46; p < 0.01), HVPG ≥ 16 mmHg (HR, 0.53; p = 0.04), or CTP class B/C (HR, 0.46; p < 0.01) but not in those with no/mild ascites, HVPG < 16 mmHg, or CTP class A. Low-dose NSBB group showed a significant reduction in mortality compared with non-NSBB (moderate/severe ascites: HR, 0.61; p = 0.02 and CTP class B/C: HR, 0.41; p < 0.01) and the effect size was stronger than the high-dose NSBB. NSBB was associated with a reduced risk of infection (HR, 0.36; p = 0.01). In the SP group, NSBB prolonged survival in patients with moderate/severe ascites (HR, 0.56; p = 0.02), HVPG ≥ 16 mmHg (HR, 0.42; p < 0.01), or CTP class B/C (HR, 0.52; p < 0.01). Low-dose NSBB was more beneficial with 56% risk reduction (p < 0.01) of mortality compared with 33% risk reduction in the high-dose NSBB (p = 0.05). Conclusion: NSBB therapy was associated with longer survival in PP and SP groups who had an advanced stage of cirrhosis. Moreover, low-dose NSBB exhibited a better benefit than a standard-titrated high-dose NSBB with better tolerability. © 2021, Asian Pacific Association for the Study of the Liver.
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DOI
10.1007/s12072-021-10160-3
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의료원 > 의료원 > Journal papers
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