Non-selective β-blockers are associated with improved survival in patients with ascites listed for liver transplantation
Non-selective β-blockers are associated with improved survival in patients with ascites listed for liver transplantation
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DOI：
10.1136/gutjnl-2013-306502
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发表时间：
2015-07-01
期刊：
影响因子：
24.5
通讯作者：
Ferguson, James W.
中科院分区：
文献类型：
--
作者：
Leithead, Joanna A.;Rajoriya, Neil;Ferguson, James W.
目的近年来的研究表明，非选择性β受体阻滞剂（NSBB）与肝硬化和难治性腹水患者的死亡率增加有关。然而，其他证据表明，NSBB可能是有益的，在这种情况下，通过减少细菌易位。我们的目的是确定NSBB的使用是否是终末期慢性肝病和腹水等待肝移植患者死亡的危险因素。设计这是一项单中心回顾性研究，纳入2007年1月至2011年7月的322例腹水患者。结果NSBB患者（n=159）和非NSBB患者（n=163）在终末期肝病和腹水等待肝移植的列表模型方面具有可比性。肝脏疾病分期评分（p=0.168）、肝细胞癌（p=0.193）和难治性腹水（35.2% vs. 37.4%，p=0.681）的发生率。82例患者死亡，221例患者接受移植，19例患者在中位随访时间72天内从列表中删除; NSBB组和非NSBB组的中位死亡时间分别为150天和54天。在多变量竞争风险考克斯模型中，与倾向风险评分匹配的非NSBB患者相比，NSBB患者的死亡率降低（HR 0.55; 95% CI 0.32至0.95，p=0.032）。类似地，在难治性腹水患者亚组（n=117）中，NSBB仍然与较少的等待名单死亡独立相关（校正HR 0.35; 95%CI 0.14至0.86，p=0.022）。我们的研究结果表明，NSBB是安全的，可能会给终末期肝病并发腹水患者带来益处。
Objective Recent data have suggested that nonselective beta-blockers (NSBB) are associated with increased mortality in patients with cirrhosis and refractory ascites. However, other evidence implies that NSBB may be beneficial in this setting by reducing bacterial translocation. Our aim was to determine whether NSBB use was a risk factor for mortality in patients with end-stage chronic liver disease and ascites awaiting liver transplantation.Design This was a single-centre retrospective study of 322 patients with ascites listed January 2007 to July 2011.Results NSBB patients (n=159) and non-NSBB patients (n=163) were comparable with regards to listing model for end-stage liver disease score (p=0.168), frequency of hepatocellular carcinoma (p=0.193) and refractory ascites (35.2% vs. 37.4%, p=0.681). 82 patients died, 221 patients were transplanted and 19 patients were removed from the list during a median follow-up duration of 72 days; the median time to death was 150 and 54 days in the NSBB and non-NSBB groups, respectively. In a multivariate competing risk Cox model, patients on NSBB had reduced mortality compared with propensity risk score-matched non-NSBB patients (HR 0.55; 95% CI 0.32 to 0.95, p=0.032). Similarly, in the subgroup of patients with refractory ascites (n=117), NSBB remained independently associated with less waitlist death (adjusted HR 0.35; 95% CI 0.14 to 0.86, p=0.022).Conclusions NSBB in patients with ascites and refractory ascites listed for liver transplantation are not detrimental, and instead are associated with reduced waitlist death. Our findings argue that NSBB are safe and may confer benefit in patients with ascites complicating end-stage liver disease.