Highlights
- •Non-selective beta-blockers (NSBB) are the backbone for the treatment of portal hypertension in patients with liver cirrhosis.
- •Relevant side effects of NSBB may occur in patients with more impaired liver function.
- •NSBB use seems to be associated with the presence of covert hepatic encephalopathy.
- •NSBB use seems to increase the incidence of overt hepatic encephalopathy in patients with decompensated cirrhosis.
Abstract
Background
Non-selective β-blockers (NSBB) are frequently used for the treatment of portal hypertension
and gastroesophageal varices in patients with liver cirrhosis; however prospective
studies investigating the potential association between NSBB use and hepatic encephalopathy
(HE) are still scarce. We investigated the potential association between NSBB use
and the presence of covert HE (CHE) as well as the development of overt HE (OHE).
Methods
224 patients with liver cirrhosis were included into this cohort study at two German
centers and followed for a median of 364 days. CHE was diagnosed by pathological results
in the PHES. Predictors for the presence of CHE or the development of OHE were analyzed
using logistic-regression or cox-regression models.
Results
39% of patients were treated with NSBB and CHE was detected in 34% of patients at
study inclusion. In logistic regression analysis, NSBB use, higher MELD score and
a history of OHE were independently associated with the presence of CHE. Cumulative
incidence of OHE was considerably higher in NSBB users than in non-users (p<0.001). In Cox-regression models NSBB use, presence of CHE, lower albumin and higher
MELD score were independently associated with the development of OHE in the whole
cohort as well as in the subgroup of patients with decompensated liver cirrhosis.
NSBB use was independently associated with higher risk of mortality or need for liver
transplantation in decompensated patients but not in the total cohort.
Conclusion
NSBB use seems to be associated with the presence of CHE as well as the development
of OHE in patients with decompensated liver cirrhosis.
Keywords
Abbreviations:
HE (hepatic encephalopathy), MHE (minimal hepatic encephalopathy), CHE (covert hepatic encephalopathy), HVPG (hepatic venous pressure gradient), HE1 (hepatic encephalopathy grade 1), PHES (Portosystemic Hepatic Encephalopathy Score), MELD (model of end stage liver disease), NAFLD (non-alcoholic fatty liver disease), NSBB (non-selective β-blocker(s))To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 29, 2020
Accepted:
August 26,
2020
Received in revised form:
August 22,
2020
Received:
July 25,
2020
Identification
Copyright
© 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
