Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire Veterans Affairs Medical Center, Richmond, VA 23249, USA.
Aliment Pharmacol Ther. 2013 Aug;38(4):407-14. doi: 10.1111/apt.12382. Epub 2013 Jun 20.
Studies evaluating outcomes associated with non-selective beta-blockers (NSBB) in cirrhosis have yielded mixed results. A major cause of death in decompensated cirrhosis is infection.
To determine the effect of NSBB use on serious infections (requiring hospitalisation) in compensated and decompensated cirrhosis.
Using data from the US Veterans Health Administration from 2001-2009, we identified two cohorts: compensated cirrhotics (n = 12,656) and decompensated cirrhotics (n = 4834). From each cohort, we identified new NSBB users and propensity-matched them 1:1 to non-users (n = 1836 each in compensated users/non-users and n = 1462 each in decompensated users/non-users). They were followed up for serious infections (median time: 3.1 years), death and transplant. We estimated adjusted hazard ratios (HR) and 95% confidence intervals (CI) from Cox regression models.
Death or transplantation occurred in 0.7% compensated and 2.7% of decompensated patients. Among decompensated cirrhotics, death (P = 0.0061) and transplantation (P = 0.0086) occurred earlier in NSBB users compared with non-users. Serious infections were observed in 4.8% of compensated cirrhotics and in 13.7% of decompensated cirrhotics. There was no difference in the rate of serious infection development in new NSBB users compared with non-users in the compensated (adjusted HR: 0.90, CI: 0.59-1.36) or in the decompensated group (adjusted HR: 1.10, CI: 0.96-1.25).
The use of non-selective beta-blockers in U.S. veterans is not associated with an increased rate of serious infections in compensated or decompensated cirrhosis.
评估非选择性β受体阻滞剂（NSBB）在肝硬化中相关结局的研究结果不一。失代偿性肝硬化患者的主要死亡原因是感染。
确定 NSBB 使用对代偿性和失代偿性肝硬化严重感染（需要住院治疗）的影响。
使用美国退伍军人健康管理局 2001-2009 年的数据，我们确定了两个队列：代偿性肝硬化患者（n = 12656）和失代偿性肝硬化患者（n = 4834）。从每个队列中，我们确定了新的 NSBB 使用者，并将其与 1：1 比例的非使用者进行倾向匹配（代偿性使用者/非使用者各 1836 例，失代偿性使用者/非使用者各 1462 例）。对他们进行了严重感染（中位时间：3.1 年）、死亡和移植的随访。我们使用 Cox 回归模型估计了调整后的危险比（HR）和 95%置信区间（CI）。
0.7%的代偿性患者和 2.7%的失代偿性患者发生死亡或移植。在失代偿性肝硬化患者中，与非使用者相比，NSBB 使用者的死亡（P = 0.0061）和移植（P = 0.0086）更早发生。代偿性肝硬化患者中有 4.8%发生严重感染，失代偿性肝硬化患者中有 13.7%发生严重感染。在代偿性（调整后的 HR：0.90，CI：0.59-1.36）或失代偿性（调整后的 HR：1.10，CI：0.96-1.25）组中，新使用 NSBB 的患者与非使用者相比，严重感染的发生率没有差异。
在美国退伍军人中使用非选择性β受体阻滞剂与代偿性或失代偿性肝硬化严重感染发生率的增加无关。
