Fallahzadeh MA, Asrani SK, Tapper EB, Saracino G, Rahimi RS. Nonselective beta-blocker use is associated with increased hepatic encephalopathy-related readmissions in cirrhosis. World J Clin Cases 2022; 10(23): 8097-8106 [PMID: 36159543 DOI: 10.12998/wjcc.v10.i23.8097]
Corresponding Author of This Article
Mohammad Amin Fallahzadeh, MD, Doctor, Department of Internal Medicine, Baylor University Medical Center, 3500 Gaston Ave, Dallas, TX 75246, United States. aminfa91@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
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/
World J Clin Cases. Aug 16, 2022; 10(23): 8097-8106 Published online Aug 16, 2022. doi: 10.12998/wjcc.v10.i23.8097
Nonselective beta-blocker use is associated with increased hepatic encephalopathy-related readmissions in cirrhosis
Mohammad Amin Fallahzadeh, Sumeet K Asrani, Elliot B Tapper, Giovanna Saracino, Robert S Rahimi
Mohammad Amin Fallahzadeh, Department of Internal Medicine, Baylor University Medical Center, Dallas, TX 75246, United States
Sumeet K Asrani, Giovanna Saracino, Robert S Rahimi, Division of Hepatology, Baylor University Medical Center, Dallas, TX 75246, United States
Elliot B Tapper, Division of Hepatology, University of Michigan, Ann Arbor, MI 48109, United States
Author contributions: Fallahazdeh MA, Asrani SK and Rahimi RS designed the research study; Fallahzadeh MA, Asrani SK, Tapper EB, Saracino G and Rahimi RS performed the acquisition, analysis and interpretation of the data; Fallahzadeh MA, Asrani SK and Rahimi RS drafted the manuscript and all authors contributed to revising the manuscript critically; all authors have read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved for publication by our Institutional Reviewer.
Informed consent statement: According to the IRB protocol and policy, all participants of the study provided informed consent indirectly about personal and medical data collection prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at aminfa91@gmail.com. Consent was not obtained but the presented data are anonymized and risk of identification is low. 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 that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohammad Amin Fallahzadeh, MD, Doctor, Department of Internal Medicine, Baylor University Medical Center, 3500 Gaston Ave, Dallas, TX 75246, United States. aminfa91@gmail.com
Received: March 7, 2022 Peer-review started: March 7, 2022 First decision: April 5, 2022 Revised: April 13, 2022 Accepted: July 11, 2022 Article in press: July 11, 2022 Published online: August 16, 2022 Processing time: 147 Days and 4 Hours
Abstract
BACKGROUND
Hepatic encephalopathy (HE) is a neurocognitive condition in cirrhosis leading to frequent hospitalizations. Nonselective beta-blockers (NSBBs) are the mainstay of pharmacologic treatment in cirrhotic patients. We hypothesized that since NSBBs decrease cardiac output and portal flow, the decreased metabolic filtering process of liver parenchyma may lead to increased HE-related hospitalizations.
AIM
To evaluate the impact of NSBB administration on HE-related readmissions in cirrhotic patients.
METHODS
In this retrospective cohort study, we included 393 patients admitted to Baylor University Medical Center for liver-related portal hypertension indications between January 2013 and July 2018. Independent predictors of the first HE-related readmissions were identified using Cox proportional hazards analysis. The cumulative incidence of the first HE-related readmissions between patients receiving NSBBs and not receiving NSBBs was examined using Fine-Gray modeling to account for the competing risk of death or liver transplantation.
RESULTS
The mean age was 58.1 ± 10.2 years and most patients fell into Child class C (49.1%) or B (43.8%). The median Model for End-Stage Liver Disease-Sodium score was 22 (IQR: 11). The cumulative incidence of the first HE-related readmissions was significantly higher in patients taking NSBBs compared to patients not receiving NSBBs (71.8% vs 41.8%, P < 0.0001). In multivariate analysis, after adjusting for demographics, markers of liver disease severity, selective beta-blocker, lactulose and rifaximin use, NSBB use [Hazard ratio: 1.74 (95%CI: 1.29-2.34)] was independently associated with the first HE-related readmissions over a median follow-up of 3.8 years.
CONCLUSION
NSBB use is independently associated with increased HE-related readmissions in patients with cirrhosis, regardless of liver disease severity.
Core Tip: In this study, we evaluated the impact of nonselective beta-blocker (NSBB) administration on hepatic encephalopathy (HE)-related readmissions in patients with Child B or C cirrhosis. After adjusting for markers of liver disease severity, NSBB use was independently associated with the first HE-related readmissions. NSBB use was also an independent predictor of HE-related admissions per person-month.
