Epidemiology

Non-selective beta-blockers do not increase infection risk in cirrhosis

Last Updated: 2013-07-03 15:30:24 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - Giving non-selective beta-blockers (NSBB) to prevent variceal bleeding in patients with cirrhosis won't raise their risk of serious infection, new data suggest.

"As pointed out in prior statements, the use of medications in influencing infection risk in cirrhosis is very important," Dr. Jasmohan S. Bajaj from Virginia Commonwealth University and McGuire Veterans Affairs Medical Center, Richmond, Virginia, told Reuters Health. "Therefore before adding any medication in a patient with cirrhosis, the risk-benefit evidence should be taken into account very seriously."

"I think a nuanced approach to NSBB is ideal since this is a retrospective data study," Dr. Bajaj said. "Therefore, only restricting those medications to patients who otherwise require it per guidelines without being unduly fearful about potentiating other issues such as infections is important. I personally therefore would not have reservations in these patients."

The study's conclusions are drawn from information the researchers obtained from the Veterans Health Administration's Austin Information Technology Center database, linked to the VHA Pharmacy Benefits Management database.

The overall sample included 12,656 veterans with compensated cirrhosis (2244 NSBB users and 10,412 non-users) and 4,834 veterans with decompensated cirrhosis (1,908 NSBB users and 2,926 non-users). From this sample, they identified propensity-matched samples that included 3,672 veterans with compensated cirrhosis and 2,924 veterans with decompensated cirrhosis.

Only 3.8% of the veterans in the propensity-matched group with compensated cirrhosis and 12.8% of those in the propensity-matched group with decompensated cirrhosis developed serious infections. There was no significant difference in rates of serious infection between NSBB users and non-users.

Compared with non-users, NSBB users did have a significantly shorter time to infection, a shorter time to death, and a shorter time to liver transplant, according to the report online June 20th in Alimentary Pharmacology & Therapeutics.

"From this study, we believe that NSBB can potentially be used when indicated (which is for prevention of variceal bleeding) without significant risk of infections in compensated or decompensated cirrhotic patients," Dr. Bajaj concluded.

SOURCE: http://bit.ly/14ObeIQ

Aliment Pharmacol Ther 2013.