Abstract
Background and Objectives: Non-selective β-blockers (NSBB) could prevent decompensation and hepatocellular carcinoma (HCC) in cirrhotic patients with clinically significant portal hypertension (CSPH), but remained uncertain for compensated cirrhotic patients without major complications. We aimed to compare the clinical outcomes between propranolol users and non-users of a CC group without major complications. Material and Methods: We conducted this population-based cohort study by using the Taiwanese Longitudinal Health Insurance Database 2000. Propranolol users (classified as cumulative defined daily dose (cDDD)) and non-PPL users were matched with a 1:1 propensity score in both cohorts. Results: This study comprised 6896 propranolol users and 6896 non-propranolol users. There was no significant impact on the development of spontaneous bacterial peritonitis between the two groups (aHR: 1.24, 95% confidence interval (CI): 0.88~1.75; p = 0.2111). Male gender, aged condition, and non-liver related diseases (peripheral vascular disease, cerebrovascular disease, dementia, pulmonary disease, and renal disease) were the independent risk factors of mortality. PPL users had significantly lower incidence of HCC development than non-users (aHR: 0.81, p = 0.0580; aHR: 0.80, p = 0.1588; and aHR: 0.49, p < 0.0001 in the groups of 1–28, 29–90, and >90 cDDD, respectively). Conclusion: The current study suggested that high cumulative doses of propranolol could decrease the risk of hepatocellular carcinoma among compensated cirrhotic patients without major complications. Further large-scale prospective studies are still required to confirm the findings in this study. Results: It remained uncertain whether non-selective β-blockers (NSBB) could prevent decompensation and hepatocellular carcinoma (HCC) in compensatory cirrhotic patients without major complications. This study aimed to compare the clinical outcomes between propranolol users and non-users of the CC group without major complications.
Highlights
Portal hypertension (PHT) is the driving force of clinical progression in patients with liver cirrhosis.Non-selective β-blockers (NSBB), available as propranolol in Taiwan, can effectively reduce PHT by the mechanism of reducing the splanchnic blood flow and lowering the cardiac output [1]
The present study analyzed data extracted from the Longitudinal Health Insurance Database 2000 (LHID 2000) of one million individuals who were randomly sampled from the year 2000 Registry for Beneficences of 23.75 million individuals involved in Taiwan’s National Health Insurance (NHI) program [15]
We focused on only cirrhotic patients without major complications, and with a later stage of chronic liver disease with the development of portal hypertension
Summary
Portal hypertension (PHT) is the driving force of clinical progression in patients with liver cirrhosis. Villanueva C, et al [4,5] reported that cirrhotic patients with the development of clinically significant portal hypertension (CSPH) had a greater hepatic vein pressure gradient (HVPG) reduction after NSBB treatment than those without. NSBB could prevent decompensation in cirrhotic patients with CSPH. Some studies reported that NSBB was not associated with increased mortality among decompensated cirrhotic patients with ascites [6,7,8,9], whereas Kalambokis GN, et al [10] found that an increased mortality was observed in Child-Pugh. The issue about the use of NSBB on the prognosis in compensated cirrhotic patients without major complications has seldom been reported. We conducted a large population-based cohort study in a national health care setting in an attempt to clarify the clinical impacts of NSBB on cirrhotic patients without major complications
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