Effect of propranolol on survival in patients with decompensated cirrhosis: A nationwide study based Danish patient registers

BACKGROUND AND AIMS: We assessed the impact of propranolol on death, risk of hepatorenal syndrome (HRS) and peritonitis in patients with cirrhosis.

METHODS: The study was a retrospective observational study and data was retrieved from Danish databases. We used our own criteria to stratify the patients into groups of patients with mildly decompensated cirrhosis or severely decompensated cirrhosis. A sub-group of patients with a history of peritonitis was also analyzed. Follow-up time was limited to two years from cohort entry. The reported hazard ratios (HR) with 95% confidence interval (CI) were based on a propensity-score matched cohort.

RESULTS: Among 3,719 patients we found 3,075 patients with mildly and 644 with severely decompensated cirrhosis. Propranolol was used by 20% of the patients. Among the patients with mildly decompensated cirrhosis, propranolol use versus non-propranolol was related with a HR of 0.7 (95%CI 0.6-0.9) and among the patients with severely decompensated cirrhosis the HR was 0.6 (95%CI 0.4-0.9). Reduced mortality was found for doses of propranolol lower than 160 mg/d only. Among 361 patients with peritonitis we found reduced mortality in the propranolol group with a HR of 0.5 (95%CI 0.3-0.8). The use of propranolol was associated with a HR of 0.4 (95%CI 0.2-0.9) for developing peritonitis during follow-up among patients with severely decompensated cirrhosis.

CONCLUSIONS: In patients with decompensated cirrhosis we found an association between propranolol use and reduced mortality risk for doses lower than 160 mg/d. This article is protected by copyright. All rights reserved.