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β-Blockers protect against spontaneous bacterial peritonitis in cirrhotic patients: a meta-analysis


Prof. Andrew K. Burroughs, Department of Surgery, The Royal Free Sheila Sherlock Liver Centre, Pond street, London NW3 2QG, UK
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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.