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

Sinha R, Lockman KA, Mallawaarachchi N et al.

Liver Unit, The Royal Infirmary of Edinburgh and The University of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK; Hepatology Laboratory, The Royal Infirmary of Edinburgh and The University of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK. Electronic address: rohit.sinha@nhs.net.

Journal of hepatology. Feb 2017.

Carvedilol, a non-selective beta-blocker (NSBB) with additional anti-alpha 1 receptor activity, is a potent portal hypotensive agent. It has been used as prophylaxis against variceal bleed. However, its safety in decompensated liver cirrhosis with ascites is still disputed. In this study, we examined whether long-term use of carvedilol in the presence of ascites is a risk factor for mortality.This was a single-centre retrospective analysis of 325 consecutive patients with liver cirrhosis and ascites presenting to our Liver Unit between 1(st) of January 2009 to 31(st) August 2012. The primary outcome was all-cause and liver-specific mortality in patients receiving or not receiving carvedilol as prophylaxis against variceal bleeding.The final cohort after propensity score matching comprised 264 patients. Baseline ascites severity and UK End Stage Liver Disease (UKELD) score between carvedilol (n=132) and non-carvedilol (n=132) groups were comparable. Median follow-up time was 2.3 years. Survival at the end of the follow-up was 24% and 2% for carvedilol and non-carvedilol group respectively (Log Rank p<0.0001). The long-term survival was significantly better in carvedilol than non-carvedilol group (Log Rank p<0.001). The survival difference remained significant after adjusting for age, gender, ascites severity, aetiology of cirrhosis, previous variceal bleed, spontaneous bacterial peritonitis prophylaxis, serum albumin and UKELD with hazard ratio of 0.59 [CI 0.44, 0.80] (p=0.001), suggesting 41% reduction in mortality risk. When stratified as per the severity of ascites, carvedilol therapy resulted in hazard ratio of 0.47 [0.29, 0.77] (p=0.003) in those with mild ascites. Even with moderate or severe ascites, carvedilol use was not associated with increased mortality risk.Long-term carvedilol therapy is not harmful in decompensated cirrhosis with ascites.The safety of carvedilol and other non-selective beta blocker in liver cirrhosis with ascites is still debated. In this study, we have shown that carvedilol therapy in patients with liver cirrhosis and ascites was associated with reduced risk of mortality, particularly in those with mild ascites. We concluded that low dose, chronic treatment with carvedilol in patients with liver cirrhosis and ascites is not detrimental. Pubmed

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