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Nonselective beta-blockers do not affect survival in cirrhotic patients with ascites
- Publication Year :
- 2018
- Publisher :
- Springer New York LLC, 2018.
-
Abstract
- Background: The role of nonselective beta-blockers in cirrhotic patients with ascites has been recently questioned; however, definitive evidence in this regard is still lacking. Aims: To analyze published data on the influence of nonselective beta-blockers as compared to control group on survival of cirrhotic patients with ascites. Methods: Computerized bibliographic search on the main databases was performed. Hazard ratios from Kaplan–Meier curves were extracted in order to perform an unbiased comparison of survival estimates. Secondary outcomes were mortality in patients with refractory ascites, pooled rate of nonselective beta-blockers interruption, spontaneous bacterial peritonitis and hepato-renal syndrome incidence. Results: Three randomized controlled trials and 13 observational studies with 8279 patients were included. Overall survival was comparable between the two groups (hazard ratio = 0.86, 0.71–1.03, p = 0.11). Study design resulted as the main source of heterogeneity in sensitivity analysis and meta-regression. Mortality in refractory ascites patients was similar in the two groups (odds ratio = 0.90, 0.45–1.79; p = 0.76). No difference in spontaneous bacterial peritonitis (odds ratio = 0.78, 0.47–1.29, p = 0.33) and hepato-renal syndrome incidence (odds ratio = 1.22, 0.48–3.09; p = 0.67) was observed. Pooled rate of nonselective beta-blockers interruption was 18.6% (5.2–32.1%). Conclusions: Based on our findings, nonselective beta-blockers should not be routinely withheld in patients with cirrhosis and ascites, even if refractory. © 2018, Springer Science+Business Media, LLC, part of Springer Nature.
- Subjects :
- Liver Cirrhosis
Hepatorenal Syndrome
Time Factors
Kaplan Meier method
Hazard ratio
overall survival
Adrenergic beta-Antagonists
complication
Review
Kaplan-Meier Estimate
Peritonitis
bacterial peritonitis
ascites
sensitivity analysis
Risk Factors
time factor
chi square distribution
Odds Ratio
Humans
controlled study
human
Mortality
Chi-Square Distribution
Incidence
microbiology
beta adrenergic receptor blocking agent
Treatment Outcome
Cirrhosis
priority journal
risk factor
NSBB
meta analysis
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.od......3566..76fc0d1116aaf5b645f15b7ddffd06fe