Non‐Selective Beta‐Blocker Use Is Associated With Lower Mortality After Decompensation in Cirrhosis: A Nationwide Target Trial Emulation
Byeong Geun Song, Myeongcheol Lee, Danbee Kang, Wonseok Kang, Ju Hyun Shim, Dong Hyun Sinn, Geum‐Youn GwakABSTRACT
Background and Aims
Non‐selective beta blockers (NSBBs) are well established for the prevention of variceal bleeding; however, their potential roles beyond this indication remain a matter of debate. We investigated the clinical outcomes of beta‐blocker use in patients with cirrhosis after hospitalisation for cirrhotic complications, excluding variceal bleeding.
Methods
Using the Korean National Health Insurance Service database, we conducted an emulated target trial among 7725 patients with viral hepatitis‐related cirrhosis hospitalised for hepatic encephalopathy, hepatorenal syndrome, ascites, and/or spontaneous bacterial peritonitis (2013–2023), comparing beta‐blocker users ( n = 2455) and non‐users ( n = 5270). The primary outcome was all‐cause death within 6 months; the secondary outcome was rehospitalisation within 3 months.
Results
Compared to beta‐blocker non‐users, those receiving beta‐blocker therapy had a lower risk of all‐cause death within 6 months [cumulative incidence of mortality 7.8% in beta‐blocker users vs. 11.0% in non‐users; adjusted hazard ratio (HR) 0.82; 95% confidence interval (CI) 0.68–0.97]. A lower risk of all‐cause death associated with beta‐blocker use was observed across complication types and patient subgroups. When analysed by dose and agent, each compared with non‐use, an association with lower mortality was observed for low‐dose beta blockers (HR 0.75, 95% CI 0.59–0.94) and for carvedilol (HR 0.55, 95% CI 0.32–0.94), whereas associations for moderate‐to‐high‐dose therapy (HR 0.90, 95% CI 0.71–1.15) and propranolol (HR 0.87, 95% CI 0.72–1.04) were not statistically significant.
Conclusions
Non‐selective beta blockers were associated with reduced mortality and a modest reduction in all‐cause readmission among patients with viral hepatitis‐related cirrhosis after non‐bleeding decompensating events (