Impact of concomitant cardiovascular medications on overall survival in patients with liver cirrhosis

Abstract

Objectives of the article

Liver cirrhosis is the end-stage liver disease associated with poor prognosis and cardiovascular comorbidity could significantly impact mortality of cirrhotic patients. We conducted a large, retrospective study to investigate the survival impact of cardiovascular co-medications in patients with liver cirrhosis.

Materials and methods

A study-specific R package was processed on the local databases of partner institutions within the Observational Health Data Sciences and Informatics consortium, namely Columbia University, New York City (NYC), USA and Ajou University School of Medicine (AUSOM), South Korea. Patients with cirrhosis diagnosed between 2000 and 2020 were included. Final analysis of the anonymous survival data was performed at Medical Faculty Mannheim, Heidelberg University.

Results

We investigated a total of 32,366 patients with liver cirrhosis. Our data showed that administration of antiarrhythmics amiodarone or digoxin presented as a negative prognostic indicator (p = 0.000 in both cohorts). Improved survival was associated with angiotensin-converting enzyme inhibitor ramipril (p = 0.005 in NYC cohort, p = 0.075 in AUSOM cohort) and angiotensin II receptor blocker losartan (p = 0.000 in NYC cohort, p = 0.005 in AUSOM cohort). Non-selective beta blocker carvedilol was associated with a survival advantage in the NYC (p = 0.000) cohort but not in the AUSOM cohort (p = 0.142). Patients who took platelet inhibitor clopidogrel had a prolonged overall survival compared to those without (p = 0.000 in NYC cohort, p = 0.003 in AUSOM cohort).

Conclusion

Concomitant cardiovascular medications are associated with distinct survival difference in cirrhotic patients. Multidisciplinary management is needed for a judicious choice of proper cardiovascular co-medications in cirrhotic patients.

Keywords:

• Liver cirrhosis
• comorbidities
• cardiovascular co-medication
• multidisciplinary management
• overall survival

Acknowledgment

We acknowledge the support of the Clinician Scientist program ‘Interfaces and Interventions in Chronic Complex Conditions’ funded by the DFG (EB 187/8-1) to M.L. The funding sources had no involvement in study design, collection, analysis and interpretation of data, writing of the report or the decision to submit the article for publication.

Author contributions

Study conception and design: Andreas Teufel and Timo Itzel. Data collection: all authors. Data analysis: all authors. Statistical analysis: Timo Itzel. Manuscript-original draft: Moying Li and Nathally Espinosa Montagut. Manuscript-review and editing: all authors. Final approval of manuscript: all authors.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Additional information

Funding

A.T. received grants from the Sino-German Center for Research Promotion [grant numbers: GZ-1546 and C-0012], the State Ministry of Baden-Wuerttemberg for Sciences, Research and Arts supporting the Clinical Cooperation Unit Healthy Metabolism at the Center for Preventive Medicine and Digital Health (grant identifier: CCU Healthy Metabolism), the Baden-Wuerttemberg Center for Digital Early Disease Detection and Prevention [grant identifier: BW-ZDFP], and the Federal Ministry of Education and Research for development of an integrated quality controlled data set for HCC [BMBF, identifier 01KD2214]. This study also received a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health &Welfare, Republic of Korea [grant number: HR16C0001]. This study was supported in part by US National Library of Medicine [grant R01 LM006910].