Evidence map›Paper›PMID 31541422›Full record

Trial reportHepatology international2019

Treatment with carvedilol improves survival of patients with acute-on-chronic liver failure: a randomized controlled trial.

Manoj Kumar, Sumit Kainth, Ashok Choudhury, Rakhi Maiwall, Lalita G Mitra, Vandana Saluja, Prashant Mohan Agarwal, Saggere Muralikrishna Shasthry, Ankur Jindal, Ankit Bhardwaj and 2 more

Registry-linked trialAbstract readRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in Hepatology international, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02583698 (Efficacy of Nonselective Beta Blockers vs Placebo in Patients With Acute-on-chronic Liver Failure With Small/ no Esophageal Varices), which is not on this map. Cited by 25 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
25citing papers in PubMed, 3 pooled it
3.0field-weighted citation impact, top 8% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02583698 nacompletednot on this map

Efficacy of Nonselective Beta Blockers vs Placebo in Patients With Acute-on-chronic Liver Failure With Small/ no Esophageal Varices

TypeinterventionalSponsorInstitute of Liver and Biliary Sciences, IndiaRan2015 to 2017Enrolled136ConditionsAcute on Chronic Liver FailureArmsCarvedilol, Placebo
3 · Its place in the literature

Who cites it

25 citing papers in PubMed, 3 syntheses or guidelines pooled it, 46 citations in OpenAlex.

  1. Pooled it
  2. Guideline
  3. Pooled it
  4. Article
  5. Review
  6. Platelet count, liver and spleen stiffness-based model reliably identifies esophageal varices needing treatment in acute-on-chronic liver failure.Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology · 2026
    Article
  7. Disease Modulating Agents in Cirrhosis.Clinics in liver disease · 2026
    Review
  8. Article
  9. Review
  10. [Effects of ascites grading and the application of non-selective beta-blockers on the 1-year prognosis of acute-on-chronic liver failure].Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology · 2025
    Article
  11. Article
  12. Review
  13. [Progress in clinical research on potential therapeutic drugs for acute-on-chronic liver failure].Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology · 2023
    Article
  14. Update in the Treatment of the Complications of Cirrhosis.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2023
    Review
  15. Article
  16. Review
  17. Review
  18. Article
  19. Liver cirrhosis and immune dysfunction.International immunology · 2022
    Review
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors at 1 institution in 1 country.

Manoj KumarDepartment of Hepatology, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India. manojkumardm@gmail.com.ORCID http://orcid.org/0000-0003-3448-8334
Sumit KainthDepartment of Hepatology, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India.
Ashok ChoudhuryDepartment of Hepatology, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India.
Rakhi MaiwallDepartment of Hepatology, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India.
Lalita G MitraDepartment of Critical Care Medicine, Institute of Liver and Biliary Sciences, New Delhi, India.
Vandana SalujaDepartment of Critical Care Medicine, Institute of Liver and Biliary Sciences, New Delhi, India.
Prashant Mohan AgarwalDepartment of Critical Care Medicine, Institute of Liver and Biliary Sciences, New Delhi, India.
Saggere Muralikrishna ShasthryDepartment of Hepatology, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India.
Ankur JindalDepartment of Hepatology, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India.
Ankit BhardwajDepartment of Clinical Research, Institute of Liver and Biliary Sciences, New Delhi, India.
Guresh KumarDepartment of Biostatistics, Institute of Liver and Biliary Sciences, New Delhi, India.
Shiv K SarinDepartment of Hepatology, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India.
Institute of Liver and Biliary Sciences · IN

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

aimsIn addition to the portal pressure reducing effect, non-selective beta blockers (NSBBs) have possible immunomodulatory and effect in reducing bacterial translocation. Recently, it has been shown that patients who are already on NSBBs should be continued on them (if feasible), if acute-on-chronic liver failure (ACLF) develops. It, however, remains unknown if patients with ACLF and no or small esophageal varices at presentation will benefit from the use of NSBBs. We studied the efficacy and safety of carvedilol in patients with ACLF in reducing mortality, variceal bleeding and non-bleeding complications.

methods136 patients with ACLF (with no or small esophageal varices and HVPG ≥ 12 mmHg) were randomized to either carvedilol (n = 66) or placebo arms (n = 70).

resultsWithin 28 days, 7 (10.6%) of 66 patients in the carvedilol group and 17 (24.3%) of 70 in the placebo group died (p= 0.044). Fewer patients in the carvedilol compared to placebo group developed acute kidney injury (AKI) (13.6% vs 35.7%, p = 0.003 and spontaneous bacterial peritonitis (SBP) (6.1% vs 21.4%, p= 0.013). Significantly, more patients in the placebo group had increase in APASL ACLF Research Consortium-ACLF grade (22.9% vs 6.1%, p= 0.007). There was no significant difference in the 90-day transplant-free survival rate and development of AKI, SBP, non-SBP infections (including pneumonia) and variceal bleed within 90 days, between the two groups.

conclusionsIn ACLF patients with either no or small esophageal varices and HVPG ≥ 12 mmHg, carvedilol leads to improved survival and fewer AKI and SBP events up to 28 days. CLINICALTRIALS. GOV IDENTIFIER NUMBER: NCT02583698.

Indexed as

Acute-On-Chronic Liver FailureAdministration, OralAdrenergic beta-AntagonistsAdultAgedCarvedilolDisease-Free SurvivalDouble-Blind MethodDrug Administration ScheduleEsophageal and Gastric VaricesFemaleGastrointestinal HemorrhageHumansIndiaMaleMiddle AgedAdrenergic beta-AntagonistsCarvedilolAcute-on-chronic liver failureBeta blockersCarvedilol

Identifiers

PMID31541422
OpenAlexW2973764321

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.