Published online Sep 7, 2018. doi: 10.3748/wjg.v24.i33.3770
Peer-review started: May 19, 2018
First decision: June 5, 2018
Revised: July 18, 2018
Accepted: July 22, 2018
Article in press: July 22, 2018
Published online: September 7, 2018
To investigate beta-blocker (BB) use in patients with cirrhosis and determine their effects on physical frailty and overall survival.
Adult outpatients with cirrhosis listed for liver transplantation underwent testing of physical frailty using the performance-based Liver Frailty Index, comprised of chair stands, grip strength, and balance testing, as well as self-reported assessments of exhaustion and physical activity. BB use was assessed from medical chart review. Univariable and multivariable logistic regression were performed to determine BB use and their association with measures of physical frailty. Competing risk analyses were performed to determine the effect of BB use on wait-list mortality, as defined by death or delisting for being too sick for transplant.
Of 344 patients, 35% were female, median age was 60, median model for end stage liver disease was 15, and 53% were prescribed a BB. Compared to those not on BB, patients on BB were similar except for percentage female (25% vs 46%; P < 0.001) and BMI (29 vs 28; P = 0.008). With respect to tests of physical frailty, BB use was not associated with increased odds of frailty (by the Liver Frailty Index), exhaustion, or low physical activity. BB use was, however, significantly associated with a decreased adjusted risk of mortality (SHR 0.55; P = 0.005).
In patients with cirrhosis awaiting liver transplantation, BB use is not associated with physical frailty. We confirmed the known survival benefits with BB use, and concerns about adverse effects should not deter their utilization when indicated.
Core tip: In patients with cirrhosis, beta-blockers are the main medical treatment for prevention of variceal bleeds, but fatigue and weakness are commonly reported side effects. This study demonstrates that use of beta-blockers is not associated with physical frailty and improves survival in patients with cirrhosis.