Age-Stratified Mortality Outcomes Associated with Nonselective Beta-Blocker Use in Patients with Decompensated Cirrhosis

Background/Objectives: Nonselective beta blockers (NSBBs) are widely used in cirrhosis for portal hypertension, but their safety in older adults with decompensated cirrhosis remains uncertain. Methods: We conducted a retrospective multicenter cohort study using the TriNetX Research Network. Adults aged 30–90 years with decompensated cirrhosis were stratified into three groups: 30–60 years, 61–90 years, and a prespecified subgroup of 81–90 years. NSBB exposure (propranolol, nadolol, or carvedilol) within 30 days of decompensation was assessed, and 1:1 propensity score matching was performed within each age group. The primary outcome was 12-month all-cause mortality. Secondary outcomes included acute kidney injury (AKI), electrolyte abnormalities, and acute care utilization. Results: After matching, 40,074 pairs (30–60 years), 96,084 pairs (61–90 years), and 19,024 pairs (81–90 years) were analyzed. NSBB use was associated with lower 12-month mortality in ages 30–60 (4.0% vs. 4.6%; RR 0.86, 95% confidence interval [CI] 0.81–0.92). 61–90-year cohort, mortality was similar between groups (7.4% vs. 7.4%; RR 0.99, 95% CI 0.96–1.02). Patients aged 81–90 years, NSBB use was associated with higher mortality (10.9% vs. 10.0%; RR 1.08, 95% CI 1.02–1.16). Across age strata, NSBB was associated with increased AKI, hyperkalemia, and acute care visits. Conclusions: NSBB therapy was associated with reduced mortality in younger adults (30–60 years) but not in older patients (61–90 years) and was associated with increased mortality among those aged 81–90 years. These findings support individualized NSBB use and suggest that patient age should be considered when weighing potential benefits and risks.