I read with great interest the article by Sersté et al.,1 who suggested that the use of beta-blockers was associated with poor survival in patients with refractory ascites. In this study, hepatocellular carcinoma, Child-Pugh class C, underlying etiologies of refractory ascites, and beta-blocker therapy were found to be independent factors predicting death. However, I think that the dose effect of propranolol also should have been included in the statistical analysis because 68 patients (88.3%) in the beta-blocker group were given more than 40 mg of propranolol per day. High doses of the drug may cause poor survival.
To the Editor:
Mevlut Kurt M.D.*, * Department of Gastroenterology, Turkiye Yuksek Ihtisas Teaching and Research Hospital, Ankara, Turkey.