Prognosis of acute variceal bleeding : is being on beta-blockers an aggravating factor? A short-term survival analysis

Non-selective beta-blockers (NSBB) are widely used since they have been proved effective in the prophylaxis of acute variceal bleeding (AVB). However, still a significant proportion of patients experience AVB whilst on treatment with NSBB and their impact on prognosis of AVB is unknown. The present study aimed at assessing the effect of being on prophylactic therapy with NSBB on 5-day failure and 6-week mortality of cirrhotic patients admitted with AVB. 142 patients were included: 49 patients were receiving prophylactic therapy with NSBB (NSBB group) and 93 patients were not (control group). There were some differences in the baseline characteristics between the groups: higher proportion of alcoholic etiology and active alcoholism (37% vs. 10%), higher platelets count and lower hematocrit at admission in the control group. However, the severity of AVB and initial treatment were similar. 5-day failure occurred in 20% of patients (14% in NSBB vs. 24% in controls; p = 0.27). The adjusted OR for 5-day failure under NSBB was 2.46; 95% CI: 0.53-11.37; p=0.25. Nineteen patients (13%) died and 2 had liver transplantation within 6-weeks. The probability of survival at 6 weeks was 96% in the NSBB group and 82% in the control group (p=0.02). After adjusting by propensity score and model for end-stage liver disease (MELD) score, the NSBB adjusted OR for 6-week mortality was 0.38; 95% CI: 0.05- 2.63; p=0.32. The estimated association between NSBB with both 5-day failure and 6-week mortality was homogenous across all MELD spectrums.