IMPACT OF NON-SELECTIVE BETA-BLOCKERS IN ADVANCED CIRRHOSIS

Dorra Trad, Meriam Sabbah*, Norsaf Bibani, Rania Zgolli, Asma Ouakaa, Héla Elloumi, Dalila Gargouri

ABSTRACT

Background: Non-selective Beta-Blockers (BBs) are widely used in the prevention of variceal hemorrhage (VH). Their benefit has been demonstrated. However, are they safe in advanced cirrhosis? The aims of this study were first to assess the effectiveness of BBs on hemorrhagic risk in advanced cirrhosis and then to study the complications observed in these patients. Methods: We conducted a retrospective study that collects all Child-Pugh C cirrhotic patients followed in the Gastroenterology Department of Habib Thameur Hospital over a period of 45 months (July 2013-March 2017). These patients were divided into 2 groups according to whether they received BBs (Group 1 ; G1) or did not (Group 2 ;G2).The follow-up of these patients was specified in both groups and the effectiveness of BBs on the bleeding risk as well as possible complications were noted and compared. Results: Four hundred and twenty patients were included. Our study focused on 90 patients. The mean age at diagnosis was 56. The sex ratio (M/F) was 0,6. Most of cirrhosis were due to viral hepatitis C (30%). The first group included 68 patients (75,6%): 37 patients were under BBs in primary prevention of VH while 31 patients received the treatment in secondary prevention. In the 2nd group, BBs were not indicated in 15 patients, 4 patients had a contraindication such as asthma (N = 1), atrio-ventricular block (N = 2) and severe heart failure (N = 2). Three patients stopped BBs for poor tolerance. VH was observed in 25% of G1 patients and in 22,7% of G2 patients.It was observed in 16% of patients under BBs in primary prevention against 35%of patients under BBs in secondary prevention. For the other complications of cirrhosis, no impact of BBs was found on the occurrence of hepatic encephalopathy, spontaneous bacterial peritonitis, hepatorenal syndrome, refractory ascites and hepatocellular carcinoma. However, BBs significantly decreased the occurrence of decompensation by ascites (95% in G2 Vs 75% in G1, p = 0,019). In addition, they significantly improved the median survival time (72 months in G1 Vs 18,8 months in G2 , p<0,0001). Conclusion: According to our results, BBs are effective, do not generate more complications and are even protective since they significantly reduced the frequency of decompensation by ascites and improved survival. They should be pursued in the advanced stages of cirrhosis.

Keywords: Cirrhosis, Beta-Blockers, Complications, Efficacy.