beta-Blockers protect against spontaneous bacterial peritonitis in cirrhotic patients: a meta-analysis.
Title | beta-Blockers protect against spontaneous bacterial peritonitis in cirrhotic patients: a meta-analysis. |
Publication Type | Journal Article |
Year of Publication | 2009 |
Authors | Senzolo, M., Cholongitas E., Burra P., Leandro G., Thalheimer U., Patch D., & Burroughs A. Kenneth |
Journal | Liver Int |
Volume | 29 |
Issue | 8 |
Pagination | 1189-93 |
Date Published | 2009 Sep |
ISSN | 1478-3231 |
Keywords | Adrenergic beta-Antagonists, Bacterial Infections, Bacterial Translocation, Databases, Bibliographic, Esophageal and Gastric Varices, Gastrointestinal Hemorrhage, Humans, Liver Cirrhosis, Peritonitis, Propranolol, Randomized Controlled Trials as Topic |
Abstract | 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. |
DOI | 10.1111/j.1478-3231.2009.02038.x |
Alternate Journal | Liver Int. |
PubMed ID | 19508620 |