Use of non-selective B-blockers is safe in hospitalised decompensated cirrhosis patients and exerts a potential anti-inflammatory effect: Data from the ATTIRE trial.
Interleukin-8
Renal dysfunction
White cell count
infection
Journal
EClinicalMedicine
ISSN: 2589-5370
Titre abrégé: EClinicalMedicine
Pays: England
ID NLM: 101733727
Informations de publication
Date de publication:
Jan 2023
Jan 2023
Historique:
received:
15
07
2022
revised:
06
10
2022
accepted:
10
10
2022
entrez:
21
11
2022
pubmed:
22
11
2022
medline:
22
11
2022
Statut:
epublish
Résumé
Nonselective B-blockers (NSBBs) are believed to have pleiotropic effects beyond reducing portal pressure. However, studies also report potential harm in patients hospitalized with cirrhosis and ascites. We therefore investigated whether NSBB use at ATTIRE trial entry (Albumin to prevent infection in chronic liver failure, 2016-19) was associated with increased renal or cardiovascular dysfunction, compared the incidence of infection and plasma markers of systemic inflammation, and examined mortality at 28-days, 3 and 6-months. In ATTIRE patients grouped by NSBB use at trial entry, we studied infection at baseline, hospital acquired infection and organ dysfunction during trial treatment period and mortality, with propensity score matching to account for differences in disease severity. There were no differences in renal or cardiovascular dysfunction between patients treated with NSBBs or not, during days 3-15 of hospitalization, despite elevated serum creatinine in NSBB patients at hospitalisation. Use of NSBBs was associated with a significant reduction in infection at hospitalization ( Our real-world data from a completed randomised trial show that use of NSBBs in decompensated cirrhosis patients is safe during hospitalisation. We also show a potential anti-inflammatory role for NSBBs which may be mediated by a downregulation of IL-8 induced leucocytosis, that was associated with reduced infection at baseline but not a survival benefit. Wellcome Trust and Department of Health and Social Care.
Sections du résumé
Background
UNASSIGNED
Nonselective B-blockers (NSBBs) are believed to have pleiotropic effects beyond reducing portal pressure. However, studies also report potential harm in patients hospitalized with cirrhosis and ascites. We therefore investigated whether NSBB use at ATTIRE trial entry (Albumin to prevent infection in chronic liver failure, 2016-19) was associated with increased renal or cardiovascular dysfunction, compared the incidence of infection and plasma markers of systemic inflammation, and examined mortality at 28-days, 3 and 6-months.
Methods
UNASSIGNED
In ATTIRE patients grouped by NSBB use at trial entry, we studied infection at baseline, hospital acquired infection and organ dysfunction during trial treatment period and mortality, with propensity score matching to account for differences in disease severity.
Findings
UNASSIGNED
There were no differences in renal or cardiovascular dysfunction between patients treated with NSBBs or not, during days 3-15 of hospitalization, despite elevated serum creatinine in NSBB patients at hospitalisation. Use of NSBBs was associated with a significant reduction in infection at hospitalization (
Interpretations
UNASSIGNED
Our real-world data from a completed randomised trial show that use of NSBBs in decompensated cirrhosis patients is safe during hospitalisation. We also show a potential anti-inflammatory role for NSBBs which may be mediated by a downregulation of IL-8 induced leucocytosis, that was associated with reduced infection at baseline but not a survival benefit.
Funding
UNASSIGNED
Wellcome Trust and Department of Health and Social Care.
Identifiants
pubmed: 36407574
doi: 10.1016/j.eclinm.2022.101716
pii: S2589-5370(22)00446-1
pmc: PMC9672423
doi:
Types de publication
Journal Article
Langues
eng
Pagination
101716Informations de copyright
© 2022 The Author(s).
Déclaration de conflit d'intérêts
There are no conflicts of interest.
Références
Gastroenterology. 2019 Jul;157(1):149-162
pubmed: 30905652
Leuk Lymphoma. 2000 Apr;37(3-4):259-71
pubmed: 10752978
Alcohol Clin Exp Res. 2000 Apr;24(4 Suppl):48S-54S
pubmed: 10803780
N Engl J Med. 2021 Mar 4;384(9):808-817
pubmed: 33657293
Liver Int. 2016 Sep;36(9):1304-12
pubmed: 26992041
Heart Vessels. 2008 Sep;23(5):334-40
pubmed: 18810582
Clin Exp Pharmacol Physiol. 2014 Sep;41(9):708-15
pubmed: 24837395
Clin Gastroenterol Hepatol. 2016 Aug;14(8):1096-1104.e9
pubmed: 26829026
J Hepatol. 2015 Mar;62(3):746-7
pubmed: 25450708
Liver Int. 2009 Sep;29(8):1189-93
pubmed: 19508620
J Gastroenterol Hepatol. 2006 Mar;21(3):581-7
pubmed: 16638103
Hepatology. 2010 Sep;52(3):1017-22
pubmed: 20583214
Gut. 2021 Sep;70(9):1758-1767
pubmed: 33199442
BMJ Open. 2016 May 04;6(5):e010902
pubmed: 27147389
J Hepatol. 2016 Mar;64(3):574-82
pubmed: 26519600
J Hepatol. 2022 Apr;76(4):959-974
pubmed: 35120736
Clin Transl Gastroenterol. 2022 May 01;13(5):e00476
pubmed: 35333783
N Engl J Med. 1987 Oct 1;317(14):856-61
pubmed: 3306385
Lancet. 1991 Jun 15;337(8755):1431-4
pubmed: 1675316
Aliment Pharmacol Ther. 2018 Jan;47(1):78-85
pubmed: 28994122
J Hepatol. 2020 Oct;73(4):842-854
pubmed: 32673741
Gut. 2012 Jul;61(7):967-9
pubmed: 22234982
Proc Natl Acad Sci U S A. 2002 Apr 30;99(9):6228-33
pubmed: 11983913
Clin Gastroenterol Hepatol. 2022 Jun;20(6):1362-1373.e6
pubmed: 34256145
Liver Transpl. 2017 Jun;23(6):733-740
pubmed: 28187503
BMJ Open. 2018 Oct 21;8(10):e023754
pubmed: 30344180
Multivariate Behav Res. 2011 May;46(3):399-424
pubmed: 21818162
BMJ Open Gastroenterol. 2019 Apr 25;6(1):e000290
pubmed: 31139428
J Cardiovasc Surg (Torino). 1999 Apr;40(2):191-5
pubmed: 10350101
JAMA. 2015 Oct 20;314(15):1637-8
pubmed: 26501539
Hepatology. 2008 Aug;48(2):580-7
pubmed: 18666235
N Engl J Med. 2010 Mar 4;362(9):823-32
pubmed: 20200386
Lancet. 2019 Apr 20;393(10181):1597-1608
pubmed: 30910320
J Hepatol. 2013 May;58(5):911-21
pubmed: 23262249
Hepatology. 2016 Nov;64(5):1806-1808
pubmed: 27016449
Neuroimmunomodulation. 2012;19(6):359-66
pubmed: 23051896