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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jennifer C Lai, MD, MBA, Assistant Professor, Gastroenterology, University of California, San Francisco, 513 Parnassus Ave, San Francisco, CA 94143, United States. jennifer.lai@ucsf.edu
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
ARTICLE HIGHLIGHTS
Research background

Patients with cirrhosis are vulnerable to developing physical frailty, and it is becoming increasingly apparent that frailty predicts poor waitlist mortality. Frequently reported side effects of beta-blockers include weakness and fatigue, which overlap with aspects of frailty.

Research motivation

There are an increasing number of studies that indicate physical frailty as a predictor of mortality in patients awaiting liver transplant. Given that beta-blockers have commonly reported side effects of fatigue and weakness, it is possible that they could accelerate physical frailty.

Research objectives

The objective of this study was to determine the association between beta-blocker use with physical frailty, exhaustion, physical activity and mortality in patients with cirrhosis.

Research methods

Three-hundred-forty-four patients with cirrhosis underwent physical frailty testing using the Liver Frailty Index, which includes chair stands, grip strength and balance testing. Data was also collected on self-reported assessments of exhaustion and amount of physical activity. Data on beta-blocker usage was obtained from chart review. Both univariable and multivariable logistic regression were performed to determine if there was an association with physical frailty and beta-blocker use.

Research results

Fifty three percent of the patients were prescribed a beta-blocker. In both univariable and multivariable models, beta-blocker users did not have increased odds of physical frailty (as defined by LFI ≥ 4.5), higher rates of exhaustion, or lower physical activity levels. Patients on beta-blockers had a 45% reduction in odds of waitlist mortality compared to patients not on beta-blockers.

Research conclusions

Our study demonstrates that in patients with cirrhosis, beta-blocker use is not associated with physical frailty, exhaustion, or lower physical activity. Furthermore, our study confirms the survival benefits of beta-blocker use.

Research perspectives

Taken together, our findings suggest that there is no association with beta-blocker use and physical frailty, and that concerns about side effects should not prevent their use when indicated. Since this is an observational study, future studies will be needed to conclude the absence of causality.