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Carvedilol use is associated with improved survival in patients with liver cirrhosis and ascites

Rohit Sinha1, Khalida A Lockman2, Nethmee Mallawaarachchi2

  • 1Liver Unit, The Royal Infirmary of Edinburgh and The University of Edinburgh, Edinburgh, United Kingdom; Hepatology Laboratory, The Royal Infirmary of Edinburgh and The University of Edinburgh, Edinburgh, United Kingdom.

Journal of Hepatology
|February 19, 2017
PubMed

Insights

Long-term carvedilol use in patients with liver cirrhosis and ascites significantly improves survival and is not associated with increased mortality. This study suggests carvedilol is safe and beneficial for this patient population.

Area of Science:

  • Hepatology and Gastroenterology
  • Pharmacology and Therapeutics
  • Clinical Medicine

Background:

  • Carvedilol, a non-selective beta-blocker (NSBB) with anti-alpha 1 activity, is used for variceal bleeding prophylaxis.
  • Safety concerns exist regarding carvedilol use in decompensated liver cirrhosis patients with ascites.
  • The impact of long-term carvedilol on mortality in cirrhotic patients with ascites requires investigation.

Purpose of the Study:

  • To evaluate the safety and efficacy of long-term carvedilol therapy in patients with liver cirrhosis and ascites.
  • To determine if carvedilol use is a risk factor for mortality in this patient group.
  • To assess the effect of carvedilol on survival rates in patients with varying degrees of ascites.

Main Methods:

  • Retrospective analysis of 325 consecutive patients with liver cirrhosis and ascites.
  • Propensity score matching created comparable groups of 132 patients receiving carvedilol and 132 not receiving it.
  • Primary outcome: all-cause and liver-specific mortality over a median follow-up of 2.3 years.

Main Results:

  • Carvedilol group showed significantly better long-term survival (24%) compared to the non-carvedilol group (2%) (log-rank p<0.0001).
  • Adjusted analysis revealed a 41% reduction in mortality risk with carvedilol (HR 0.59, 95% CI: 0.44-0.80, p=0.001).
  • Carvedilol use was not associated with increased mortality, even in patients with moderate to severe ascites.

Conclusions:

  • Long-term carvedilol therapy is safe and beneficial for patients with decompensated liver cirrhosis and ascites.
  • Carvedilol use is associated with a significant reduction in mortality risk in this population.
  • The protective effect was observed across different ascites severity levels, suggesting broad applicability.
Abstract

Keywords:
AscitesCarvedilolDecompensated liver diseaseNon-selective beta-blockers

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