Beta‐blockers in hospitalised patients with cirrhosis and ascites: mortality and factors determining discontinuation and reinitiation

Summary Background It has been suggested that beta‐blockers may increase mortality in patients with cirrhosis and refractory ascites but the effect of beta‐blockers discontinuation or reinitiation has not been examined. Aims To compare, in hospitalised patients with cirrhosis and ascites, the effect of BB on survival and to examine the effect/predictors of beta‐blockers discontinuation and reinitiation. Methods Sub‐analysis of NACSELD (North American consortium for the study of end‐stage liver disease, database containing prospective data on hospitalised patients with cirrhosis) data from 7 centres enrolling >100 patients with ascites. Data on BB discontinuation and reinitiation were collected by chart review. Results Seven hundred and sixteen patients, 307 (43%) on beta‐blockers at admission and 366 (51%) with refractory ascites, were followed to death or hospital discharge. Beta‐blocker use was associated with a lower white blood cell count at admission. Beta‐blocker use in hospitalised patients with ascites was not associated with a higher mortality, even in those with refractory ascites. No significant changes in mean arterial pressure ( MAP ) were observed between groups. Discontinuation of beta‐blockers (49%) was driven by low MAP , infection and acute kidney injury at time of discontinuation but was not associated with a higher mortality. Beta‐blocker reinitiation occurred in 40% prior to discharge and was mainly driven by an increase in MAP . Conclusions Beta‐blocker use is safe in patients with cirrhosis and ascites (including those with refractory ascites) provided beta‐blockers are discontinued in the presence of a low MAP and reinitiated once MAP reincreases. A potentially beneficial anti‐inflammatory effect of beta‐blockers is suggested.