β-BLOCKERS LOWER FIRST DECOMPENSATION IN PATIENTS WITH CIRRHOSIS AND ENDURING PORTAL HYPERTENSION AFTER ETIOLOGICAL TREATMENT

Abstract

Non-selective beta-blockers (NSBB) can lower the risk of first decompensation in patients with cirrhosis and clinically significant portal hypertension (CSPH) (identified by a hepatic venous pressure gradient ≥10 mmHg) with active etiology. Our aim was to examine the effect of NSBB on first decompensation occurrence in patients with cirrhosis and enduring CSPH after etiological treatment. Patients with compensated cirrhosis and clinical evidence of CSPH (gastroesophageal varices -GEV- and/or spontaneous portosystemic collaterals- SPSS) after two years from etiological treatment. Primary endpoint was first decompensation (occurrence of variceal bleeding, ascites, or hepatic encephalopathy) in patients on-NSBB vs. off-NSBB. Final cohort included 406 patients. Baseline characteristics of patients on-NSBB (n=187) and off-NSBB (n=219) were comparable, except for signs of PH that were more pronounced in the on-NSBB group. During a mean follow-up of 32 months, 127 (31%) patients decompensated, with ascites being the most common (77%) decompensating event. Decompensation rates were lower in patients on-NSBB (16% vs 44%, p<0,0001). The benefit of NSBB on decompensation was maintained in patients with small GEV (17% vs 43%, p<0,0001), in those with SPSS only (8% vs 43%, p=0,003) and in each different etiology, including HCV-cured cirrhosis (9% vs 32%, p<0,0001). At Cox regression analysis, Hemoglobin, Child-Pugh, MELD-Na, diabetes at baseline and previous bacterial infections were independent predictors of decompensation, while NSBB-use had a protective effect (HR 0,32, 95% CI 0,20-0,49; p<0,0001). NSBB-use significantly reduced bacterial infection rates (HR 0,36, 95% CI 0,22-0,58; p<0,0001). NSBB decrease the risk of first decompensation in patients with cirrhosis and enduring CSPH after etiological treatment.