Non-Selective Beta-Blockers Decrease Infection, Acute Kidney Injury Episodes, and Ameliorate Sarcopenic Changes in Patients with Cirrhosis: A Propensity-Score Matching Tertiary-Center Cohort Study.

Tzu-Hao Li,Chih-Wei Liu,Ying-Ying Yang,Yu-Lien Tsai,Han-Chieh Lin,Chang-Youh Tsai,Shiang-Fen Huang,Ming-Chih Hou,Chia-Chang Huang

doi:10.3390/jcm10112244

Abstract

Background: Cirrhotic complications resulting from portal hypertension can be considerably reduced by non-selective beta-blockers (NSBBs); however, scarce studies have investigated therapeutic agents for other complications. We aimed to investigate the effects of NSBBs on common cirrhotic complications of infection, acute kidney injury (AKI), chronic renal function declination, and sarcopenic changes. Methods: Medical records of hospitalization for cirrhosis with at least a 4-year follow-up were analyzed and selected using propensity-score matching (PSM). Generalized estimating equation (GEE) was applied to assess the association of NSBBs with infection requiring hospitalization and AKI. Chronic renal function declination was evaluated by slope of regression lines derived from reciprocal of the serum creatinine level. The covariates of CT-measured skeletal muscle index (SMI) alterations were analyzed by generalized linear mixed model. Results: Among the 4946 reviewed individuals, 166 (83 NSBB group, 83 non-NSBB group) were eligible. Using GEE, Charlson comorbidity index, Child-Pugh score and non-NSBB were risk factors for infection; non-NSBB group revealed a robust trend toward AKI, showed no significant difference with chronic renal function declination of NSBB group, and was negatively associated with SMI alteration. Conclusion: Chronic NSBB use lowered the episodes of infection requiring hospitalization and AKIs, whereas non-NSBB was associated with sarcopenic changes.

Highlights

Cirrhosis is a deleterious multisystem condition, comprising the complications associated with portal hypertension (PH), such as ascites, variceal bleeding, spontaneous bacterial peritonitis (SBP), hepatic encephalopathy (HE) and hepatorenal syndrome (HRS) [1].in cirrhosis, intestinal bacterial translocation aggravates proinflammatory and profibrogenic reaction, and the resultant endotoxemia leads to immune dysfunction as well as antimicrobial resistance [2,3]; association between bacterial translocation and HE or renal dysfunction has been reported [3,4]
We evaluated the area of the total skeletal muscle at the third lumbar (L3) level in computed tomography (CT) images through picture archiving and communication system, in which the skeletal muscles were identified by the Hounsfield unit threshold range of −29 to 150 at the corresponding site
During the 4-year observation period, there were 34 independent infection episodes requiring hospitalization of 24 subjects in the non-selective beta-blocker (NSBB) group, and 50 episodes in 40 subjects in the non-NSBB group; three and four episodes of SBP occurred in the NSBB and nonNSBB groups, respectively (p = 0.719)

Summary

Introduction

Cirrhosis is a deleterious multisystem condition, comprising the complications associated with portal hypertension (PH), such as ascites, variceal bleeding, spontaneous bacterial peritonitis (SBP), hepatic encephalopathy (HE) and hepatorenal syndrome (HRS) [1].in cirrhosis, intestinal bacterial translocation aggravates proinflammatory and profibrogenic reaction, and the resultant endotoxemia leads to immune dysfunction as well as antimicrobial resistance [2,3]; association between bacterial translocation and HE or renal dysfunction has been reported [3,4]. Cirrhotic complications resulting from portal hypertension can be considerably reduced by non-selective beta-blockers (NSBBs); scarce studies have investigated therapeutic agents for other complications. We aimed to investigate the effects of NSBBs on common cirrhotic complications of infection, acute kidney injury (AKI), chronic renal function declination, and sarcopenic changes. Generalized estimating equation (GEE) was applied to assess the association of NSBBs with infection requiring hospitalization and AKI. Using GEE, Charlson comorbidity index, Child-Pugh score and non-NSBB were risk factors for infection; nonNSBB group revealed a robust trend toward AKI, showed no significant difference with chronic renal function declination of NSBB group, and was negatively associated with SMI alteration. Conclusion: Chronic NSBB use lowered the episodes of infection requiring hospitalization and AKIs, whereas non-NSBB was associated with sarcopenic changes

Objectives

Methods

Results

Discussion

Conclusion