Retrospective Cohort Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 7, 2018; 24(33): 3770-3775
Published online Sep 7, 2018. doi: 10.3748/wjg.v24.i33.3770
Beta-blockers and physical frailty in patients with end-stage liver disease
Selena Z Kuo, Blanca Lizaola, Hilary Hayssen, Jennifer C Lai
Selena Z Kuo, Blanca Lizaola, Hilary Hayssen, Jennifer C Lai, Division of Gastroenterology/Hepatology, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, United States
Author contributions: Kuo SZ and Lai JC designed research, and analyzed data; Kuo SZ performed research; Kuo SZ, Lizaola B, Hayssen H and Lai JC wrote the paper.
Supported by the Paul B. Beeson Career Development Award in Aging Research, No. K23AG048337.
Institutional review board statement: This study was reviewed and approved by the International Review Board of the University of California, San Francisco
Conflict-of-interest statement: We have no conflict of interests to disclose.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – Checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Jennifer C Lai, MD, MBA, Assistant Professor, Gastroenterology, University of California, San Francisco, 513 Parnassus Ave, San Francisco, CA 94143, United States.
Telephone: +415-476-2777 Fax: +415-476-0659
Received: May 19, 2018
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.

Keywords: Beta-blockers, Cirrhosis, End-stage liver disease, Frailty

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.