Does acute response to safe dose of carvedilol vary across different child class of liver disease: A large cohort hemodynamic study

Abstract

Background: Carvedilol is a nonselective beta-blocker with an additional alpha 1 adrenoceptor blocking action, causing a much greater decrease in portal pressure as compared to propranolol. Materials and Methods: One hundred two consecutive patients of cirrhosis of the liver with significant portal hypertension were included, and hepatic venous pressure gradient (HVPG) was measured at the baseline and after 90 min of administration of 12.5 mg carvedilol. Results: A total of 102 patients with mean age of 58.3 ± 6.6 years were included. A total of 42.2%, 31.9%, and 26.6% patients had child Class A, child Class B, and Child Class C cirrhosis, respectively. Mean baseline HVPG was 16.75 ± 2.12 mmHg that dropped to 13.07 ± 2.32 mmHg, after 90 min of administration of 12.5 mg of carvedilol. The mean drop of HVPG was 4.5 ± 2.2 mmHg and 2.4 ± 1.9 mmHg between responders and nonresponders, respectively. Overall, 52 patients (51%) showed acute response while 50 (49%) were nonresponders. Baseline low cardiac output (CO) and high mean arterial pressure (MAP) were significant predictors of acute response on univariate analysis. On multivariate analysis, low baseline CO was found as an independent predictor. Conclusion: Carvedilol is a drug of choice among beta-blockers for primary prophylaxis of variceal bleed. Hemodynamic parameters like baseline low CO high MAP are significantly predicting acute response while as etiology, child class, and variceal size are not significantly associated with acute response to a safe dose of carvedilol.