β-Blockers protect against spontaneous bacterial peritonitis in cirrhotic patients: a meta-analysis
Article first published online: 1 MAY 2009
© 2009 John Wiley & Sons A/S
Volume 29, Issue 8, pages 1189–1193, September 2009
How to Cite
Senzolo, M., Cholongitas, E., Burra, P., Leandro, G., Thalheimer, U., Patch, D. and Burroughs, A. K. (2009), β-Blockers protect against spontaneous bacterial peritonitis in cirrhotic patients: a meta-analysis. Liver International, 29: 1189–1193. doi: 10.1111/j.1478-3231.2009.02038.x
- Issue published online: 3 AUG 2009
- Article first published online: 1 MAY 2009
- Received 26 December 2008Accepted 10 February 2009
- non selective beta blockers;
- spontanous bacterial peritonitis
Introduction: Bacterial infections have been hypothetized to be a trigger of variceal bleeding in cirrhotic patients and β-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 β-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 β-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 β-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 β-blockers in preventing SBP in ascitic cirrhotics, independent of haemodynamic response. Further formal RCTs are needed to confirm this finding.