Introduction: β-blockers have well established role in the prevention of variceal hemorrhage. In addition, several studies have indicated that β-blockers could be helpful in preventing spontaneous bacterial peritonitis (SBP) inpatients with cirrhosis. On the other hand, some authors have suggested that use of β-blockers could be associated with higher mortality in patients with advanced cirrhosis. Our aim was to evaluate the role of β-blockers in prevention of SBP and subsequent survival in patients with liver cirrhosis.
Methods: We performed a systematic search of published articles and abstracts from major gastroenterology meetings for studies comparing the risk of SBP with and without β-blockers in patients with liver cirrhosis. We calculated Odds ratio (OR) of studies with dichotomous outcomes of the event. Then we used Mantel-Haenszel method to pool the OR with generic inverse analysis of incidence of SBP into fixed or random effect model meta-analyses. In addition, we pooled data of mortality with and without beta-blockers, where provided, among the studies included in the meta-analysis.
Results: A total of 4644 patients in eleven studies were included in the meta-analysis. Our analysis showed significant heterogeneity between the studies which was adjusted using ‘Random-effect' model. Our analysis did not show a significant difference in the use of β-blockers and the incidence of SBP (OR= 0.93; Confidence Interval (CI) 0.78, 1.10) (Fig. 1). In addition, there was no significant difference in the mortality with the use of β-blockers (OR= 1.27; CI 0.41, 3.96) (Fig. 2).
Conclusion: Conclusions: Our analysis did not show any benefit of β-blockers in prevention of SBP in liver cirrhosis. Additionally, use of β-blockers was not associated with an increased mortality in cirrhosis.