beta-Blockers protect against spontaneous bacterial peritonitis in cirrhotic patients: a meta-analysis

Liver Int. 2009 Sep;29(8):1189-93. doi: 10.1111/j.1478-3231.2009.02038.x. Epub 2009 May 1.


Introduction: Bacterial infections have been hypothetized to be a trigger of variceal bleeding in cirrhotic patients and beta-blockers may have a protective effect by decreasing bacterial translocation, reducing portal pressure. The aim of our study was to evaluate the possible role of beta-blockers in preventing spontaneous bacterial peritonitis (SBP) in patients with liver cirrhosis and ascites.

Materials and methods: Extensive search of the literature including randomized controlled trial (RCT) and non-RCT of primary and secondary prophylaxis for variceal bleeding in cirrhotics using beta-blockers were evaluated. We performed a meta-analysis using the occurrence of SBP as endpoint in all the studies, using the random effect model.

Results: Three RCT and three retrospective studies in which beta-blockers were evaluated against no treatment for the prevention of SBP in ascitic cirrhotics were included. There was a statistically significant difference of 12.1%, P<0.001 in favour of propranolol in preventing SBP, which was confirmed by sensitivity analysis evaluating only RCTs (7.8% difference). The effect was still present when haemodynamic responders were compared with non-responders.

Conclusions: This analysis suggests a role of beta-blockers in preventing SBP in ascitic cirrhotics, independent of haemodynamic response. Further formal RCTs are needed to confirm this finding.

Publication types

  • Meta-Analysis

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use*
  • Bacterial Infections / etiology
  • Bacterial Infections / prevention & control*
  • Bacterial Translocation / drug effects
  • Databases, Bibliographic
  • Esophageal and Gastric Varices / drug therapy
  • Esophageal and Gastric Varices / etiology
  • Gastrointestinal Hemorrhage / etiology
  • Gastrointestinal Hemorrhage / prevention & control
  • Humans
  • Liver Cirrhosis / complications
  • Liver Cirrhosis / drug therapy*
  • Peritonitis / microbiology
  • Peritonitis / prevention & control*
  • Propranolol / therapeutic use
  • Randomized Controlled Trials as Topic


  • Adrenergic beta-Antagonists
  • Propranolol