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Abstract
Objective. It is currently discussed if beta-blockers exert harmful effects and increase mortality in patients with cirrhosis and refractory ascites. In this study, we provide an overview of the available literature in this field in combination with a retrospective analysis of 61 patients with cirrhosis and refractory ascites in a tertiary unit. Material and methods. We performed a systematic search of literature in May 2014. In addition, 61 patients with cirrhosis and ascites were identified and followed from development of refractory ascites until death or end of follow-up. Results. Fourteen trials (9 trials on propranolol, 1 case-control study and 4 retrospective analyses) were identified. One trial suggested an increased mortality in patients treated with beta-blockers and refractory ascites. The results of the remaining trials were inconclusive. No increase in mortality among beta-blocker-treated patients was found in the present retrospective analysis. Conclusions. Treatment with beta-blockers may increase mortality in patients with cirrhosis and refractory ascites. However, the current evidence is sparse and high-quality studies are warranted to clarify the matter.
Author contributions: Nina Kimer (NK), Martin Feineis (MF) and Flemming Bendtsen (FB) evolved study concept and design. NK performed the literature search. MF, SM and NK extracted and analyzed data for the retrospective analysis. All authors participated in the interpretation of analyses and literature. NK and MF drafted the manuscript. All authors reviewed and commented on drafts of the paper. All authors have approved the final draft of the manuscript.
Declaration of interest: Flemming Bendtsen has received grants from The Research Foundation, The Capital Region of Denmark. Søren Møller has received grants from Novo Nordisk Foundation and Lundbeck Foundation. Nina Kimer and Martin Feineis declare no relevant conflicts of interest.