Clin Mol Hepatol.  2012 Jun;18(2):203-212. 10.3350/cmh.2012.18.2.203.

Is there any vindication for low dose nonselective beta-blocker medication in patients with liver cirrhosis?

• Kim TW
• Kim HJ
• Chon CU
• Won HS
• Park JH
• Park DI
• Cho YK
• Sohn CI
• Jeon WK
• Kim BI

• KMID: 1743728
• DOI: http://doi.org/10.3350/cmh.2012.18.2.203

Abstract

BACKGROUND/AIMS
Nonselective beta-blockers (NSBBs), such as propranolol, reportedly exert a pleiotropic effect in liver cirrhosis. A previous report suggested that survival was higher in patients receiving adjusted doses of NSBBs than in ligation patients. This study investigated whether low-dose NSBB medication has beneficial effects in patients with liver cirrhosis, especially in terms of overall survival.
METHODS
We retrospectively studied 273 cirrhotic patients (199 males; age 53.6+/-10.2 years, mean+/-SD) who visited our institution between March 2003 and December 2007; follow-up data were collected until June 2011. Among them, 138 patients were given a low-dose NSBB (BB group: propranolol, 20-60 mg/day), and the remaining 135 patients were not given an NSBB (NBB group). Both groups were stratified randomly according to Child-Turcotte-Pugh (CTP) classification and age.
RESULTS
The causes of liver cirrhosis were alcohol (n=109, 39.9%), hepatitis B virus (n=125, 45.8%), hepatitis C virus (n=20, 7.3%), and cryptogenic (n=19, 7.0%). The CTP classes were distributed as follows: A, n=116, 42.5%; B, n=126, 46.2%; and C, n=31, 11.4%. Neither the overall survival (P=0.133) nor the hepatocellular carcinoma (HCC)-free survival (P=0.910) differed significantly between the BB and NBB groups [probability of overall survival at 4 years: 75.1% (95% CI=67.7-82.5%) and 81.2% (95% CI=74.4-88.0%), respectively; P=0.236]. In addition, the delta CTP score did not differ significantly between the two groups.
CONCLUSIONS
Use of low-dose NSBB medication in patients with liver cirrhosis is not indicated in terms of overall and HCC-free survival.

Keyword

Nonselective beta-blockers; Liver cirrhosis; Overall survival; Child-Turcotte-Pugh

MeSH Terms

Adrenergic beta-Antagonists/*therapeutic use
Adult
Aged
Alcohol Drinking
Carcinoma, Hepatocellular/complications/diagnosis
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Kidney Failure, Chronic/complications/diagnosis
Liver Cirrhosis/complications/*drug therapy/mortality
Liver Neoplasms/complications/diagnosis
Male
Middle Aged
Predictive Value of Tests
Proportional Hazards Models
Propranolol/*therapeutic use
Retrospective Studies
Severity of Illness Index