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Nonselective beta-blocker use is associated with increased hepatic encephalopathy-related readmissions in cirrhosis

Mohammad Amin Fallahzadeh1, Sumeet K Asrani2, Elliot B Tapper3

  • 1Department of Internal Medicine, Baylor University Medical Center, Dallas, TX 75246, United States. aminfa91@gmail.com.

World Journal of Clinical Cases
|September 26, 2022
PubMed

Insights

Nonselective beta-blockers (NSBBs) increase hospital readmissions for hepatic encephalopathy (HE) in cirrhosis patients. This finding holds true regardless of liver disease severity, suggesting a need to reconsider NSBB use in this population.

Area of Science:

  • Hepatology
  • Cardiology
  • Pharmacology

Background:

  • Hepatic encephalopathy (HE) is a common neurocognitive complication in cirrhosis patients, frequently leading to hospitalizations.
  • Nonselective beta-blockers (NSBBs) are standard treatment for portal hypertension in cirrhosis.
  • A potential link between NSBBs, reduced liver metabolic filtering, and increased HE hospitalizations was hypothesized.

Purpose of the Study:

  • To investigate the association between NSBB administration and HE-related readmissions in patients with cirrhosis.
  • To determine if NSBBs impact the incidence of HE-related hospitalizations.

Main Methods:

  • Retrospective cohort study of 393 cirrhotic patients admitted for portal hypertension indications.
  • Cox proportional hazards analysis and Fine-Gray modeling were used to identify predictors of HE readmissions and account for competing risks (death, liver transplantation).

Main Results:

  • Patients on NSBBs had a significantly higher cumulative incidence of first HE-related readmissions (71.8%) compared to those not on NSBBs (41.8%).
  • NSBB use was independently associated with an increased risk of HE-related readmissions (Hazard Ratio: 1.74).
  • This association persisted after adjusting for disease severity and other medications.

Conclusions:

  • Nonselective beta-blocker use is independently linked to a higher rate of hepatic encephalopathy-related readmissions in cirrhosis patients.
  • The findings suggest that NSBBs may exacerbate HE, irrespective of the severity of liver disease.
  • Clinical practice may need to re-evaluate the role of NSBBs in managing cirrhotic patients prone to HE.
Abstract

Keywords:
Altered mental statusAscitesEsophageal varicesHospitalizationLiver diseasePortal hypertension

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