Department of Medicine, University of California-San Francisco, San Francisco, California, USA.
Hepatol Commun. 2023 Sep 27;7(10). doi: 10.1097/HC9.0000000000000255. eCollection 2023 Oct 1.
Nonselective beta-blockers (NSBB) protect patients with compensated cirrhosis; however, it is unclear if NSBB is associated with acute kidney injury (AKI) in patients with decompensated cirrhosis. We aimed to determine if the use of NSBB was associated with an increased risk of stage II AKI or greater and waitlist mortality (WLM) among patients with decompensated cirrhosis awaiting liver transplant stratified by cirrhosis severity.
Included were 1816 outpatients listed for liver transplantation at UCSF from June 2012 to April 2022. Our primary outcome was stage 2 AKI (>200% increase in serum creatinine). Our secondary outcome was WLM (all-cause mortality). Our primary exposure was the use of any NSBB derived using natural language processing of clinical notes. Multivariable Cox proportional hazards models with time-dependent variables were used to determine the HR of NSBB use on stage 2 AKI and WLM, stratified by Child-Pugh Score.
The average age of the cohort was 58 years old, with 35% identifying as female. In multivariable time-dependent models, NSBB use was associated with 1.53 × (95 CI 1.19-1.97) the hazard of stage 2 AKI in the cohort overall and 1.80 × (95 CI 1.26-2.57) among those with Child C cirrhosis, respectively. Similarly, NSBB use was associated with 1.30 × (95 CI 1.07-1.59) and 1.45 × (95 CI 1.03-2.03) the hazard of WLM, overall and in Child C, respectively. NSBB use was not significantly associated with AKI nor WLM among those with Child A.
NSBB use is associated with Stage 2 AKI and WLM in patients awaiting liver transplantation and Child C cirrhosis. These data suggest cautious use of NSBBs in patients in this population.
非选择性β受体阻滞剂（NSBB）可保护代偿期肝硬化患者；然而，非选择性β受体阻滞剂是否与失代偿期肝硬化患者的急性肾损伤（AKI）相关尚不清楚。我们旨在确定在按肝硬化严重程度分层的失代偿期肝硬化患者中，使用非选择性β受体阻滞剂是否与更高风险的 II 期 AKI或以上和等待肝移植的患者的等待名单死亡率（WLM）相关。
本研究纳入了 2012 年 6 月至 2022 年 4 月期间在 UCSF 接受肝移植名单的 1816 名门诊患者。我们的主要结局是 II 期 AKI（血清肌酐增加 200%以上）。次要结局是 WLM（全因死亡率）。我们的主要暴露是使用自然语言处理临床记录中获得的任何 NSBB。使用具有时间依赖性变量的多变量 Cox 比例风险模型来确定 NSBB 使用与 II 期 AKI 和 WLM 的 HR，按 Child-Pugh 评分分层。
队列的平均年龄为 58 岁，其中 35%为女性。在多变量时间依赖性模型中，NSBB 使用与总体队列中 II 期 AKI 的风险增加 1.53 倍（95%CI 1.19-1.97）和 Child C 肝硬化患者中的风险增加 1.80 倍（95%CI 1.26-2.57）分别相关。同样，NSBB 使用与 WLM 的风险增加 1.30 倍（95%CI 1.07-1.59）和 1.45 倍（95%CI 1.03-2.03）相关，总体和 Child C 分别相关。在 Child A 患者中，NSBB 使用与 AKI 或 WLM 无显著相关性。
NSBB 使用与等待肝移植和 Child C 肝硬化患者的 II 期 AKI 和 WLM 相关。这些数据表明，在该人群中应谨慎使用 NSBB。
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