Beta-blockers in hospitalised patients with cirrhosis and ascites: mortality and factors determining discontinuation and reinitiation

Aliment Pharmacol Ther. 2018 Jan;47(1):78-85. doi: 10.1111/apt.14366. Epub 2017 Oct 9.


Background: It has been suggested that beta-blockers may increase mortality in patients with cirrhosis and refractory ascites but the effect of beta-blockers discontinuation or reinitiation has not been examined.

Aims: To compare, in hospitalised patients with cirrhosis and ascites, the effect of BB on survival and to examine the effect/predictors of beta-blockers discontinuation and reinitiation.

Methods: Sub-analysis of NACSELD (North American consortium for the study of end-stage liver disease, database containing prospective data on hospitalised patients with cirrhosis) data from 7 centres enrolling >100 patients with ascites. Data on BB discontinuation and reinitiation were collected by chart review.

Results: Seven hundred and sixteen patients, 307 (43%) on beta-blockers at admission and 366 (51%) with refractory ascites, were followed to death or hospital discharge. Beta-blocker use was associated with a lower white blood cell count at admission. Beta-blocker use in hospitalised patients with ascites was not associated with a higher mortality, even in those with refractory ascites. No significant changes in mean arterial pressure (MAP) were observed between groups. Discontinuation of beta-blockers (49%) was driven by low MAP, infection and acute kidney injury at time of discontinuation but was not associated with a higher mortality. Beta-blocker reinitiation occurred in 40% prior to discharge and was mainly driven by an increase in MAP.

Conclusions: Beta-blocker use is safe in patients with cirrhosis and ascites (including those with refractory ascites) provided beta-blockers are discontinued in the presence of a low MAP and reinitiated once MAP reincreases. A potentially beneficial anti-inflammatory effect of beta-blockers is suggested.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use*
  • Aged
  • Ascites / complications
  • Ascites / mortality*
  • End Stage Liver Disease / complications
  • Female
  • Humans
  • Liver Cirrhosis / drug therapy*
  • Liver Cirrhosis / mortality
  • Male
  • Middle Aged
  • Prospective Studies


  • Adrenergic beta-Antagonists