ReviewClinical and molecular hepatology2021
β-blockers in advanced cirrhosis: More friend than enemy.
Review in Clinical and molecular hepatology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 2 of them syntheses that pooled 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.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
23 citing papers in PubMed, 2 syntheses or guidelines pooled it, 35 citations in OpenAlex.
- Non-selective beta-blockers and the incidence of hepatocellular carcinoma in patients with cirrhosis: a meta-analysis.Frontiers in pharmacology · 2023Pooled it
- Humoral Immunogenicity to SARS-CoV-2 Vaccination in Liver Transplant Recipients: A Systematic Review and Meta-Analysis.International journal of biological sciences · 2022Pooled it
- Cardiovascular Complications of Chronic Liver Disease.Circulation · 2026Review
- Clinical, Microbiological, and Antibiotic Treatment Characteristics of Bacterial Infections in Patients with Liver Cirrhosis in China: A Multicenter Study.Journal of clinical and translational hepatology · 2025Article
- Cirrhotic Cardiomyopathy: Bridging Hepatic and Cardiac Pathophysiology in the Modern Era.Journal of clinical medicine · 2025Review
- Potential therapies for acute-on-chronic liver failure.Liver international : official journal of the International Association for the Study of the Liver · 2025Review
- The effect of propranolol on gastrointestinal motility and permeability in patients with cirrhosis and significant portal hypertension.BMC gastroenterology · 2024Article
- Microarray analysis demonstrates up-regulation of the endothelin-1 gene with compensatory down-regulation of the ETA receptor gene in human portal vein.Bioscience reports · 2024Article
- Therapies for Cirrhotic Cardiomyopathy: Current Perspectives and Future Possibilities.International journal of molecular sciences · 2024Review
- Cardiomyopathy in cirrhosis: From pathophysiology to clinical care.JHEP reports : innovation in hepatology · 2024Review
- Changes of the bacterial composition in duodenal fluid from patients with liver cirrhosis and molecular bacterascites.Scientific reports · 2023Article
- Gut liver brain axis in diseases: the implications for therapeutic interventions.Signal transduction and targeted therapy · 2023Review
- In severe alcohol-related hepatitis, acute kidney injury is prevalent, associated with mortality independent of liver disease severity, and can be predicted using IL-8 and micro-RNAs.Alimentary pharmacology & therapeutics · 2023Article
- Hepatorenal syndrome: Current concepts and future perspectives.Clinical and molecular hepatology · 2023Review
- The Intestinal Microbiota in the Development of Chronic Liver Disease: Current Status.Diagnostics (Basel, Switzerland) · 2023Review
- Role of Galectin in Cardiovascular Conditions including Cirrhotic Cardiomyopathy.Pharmaceuticals (Basel, Switzerland) · 2023Review
- Dysregulated Calcium Handling in Cirrhotic Cardiomyopathy.Biomedicines · 2023Review
- Correspondence on Editorial regarding "Baveno-VII criteria to predict decompensation and initiate non-selective beta-blocker in compensated advanced chronic liver disease patients".Clinical and molecular hepatology · 2023Article
- Non-invasive tests-based risk stratification: Baveno VII and beyond.Clinical and molecular hepatology · 2023Article
- Prolonged QT Interval in Cirrhosis: Twisting Time?Gut and liver · 2022Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Nonselective beta-adrenergic blocker (NSBB) therapy for the prevention of initial and recurrent gastrointestinal bleeding in cirrhotic patients with gastroesophageal varices has been used for the past four decades. NSBB therapy is considered the cornerstone of treatment for varices, and has become the standard of care. However, a 2010 study from the group that pioneered β-blocker therapy suggested a detrimental effect of NSBBs in decompensated cirrhosis, especially in patients with refractory ascites. Since then, numerous additional studies have incompletely resolved whether NSBBs are deleterious, although more recent evidence weighs against a harmful effect. The possibility of a "therapeutic window" has also been raised. We aimed to review the literature to analyze the pros and cons of using NSBBs in patients with cirrhosis, not only with respect to bleeding or mortality but also to other potential benefits and risks. β-blockers are highly effective in preventing first bleeding and recurrent bleeding. Furthermore, NSBBs improve congestion/ischemia of the gut mucosa, decrease intestinal permeability, and therefore indirectly alleviate systemic inflammation. β-blockers shorten the electrocardiographic prolonged QTc interval and may also decrease the incidence of hepatocellular carcinoma. On the other hand, the possibility of deleterious effects in cirrhosis has not been completely eliminated. NSBBs may be associated with an increased risk of portal vein thrombosis, although this could be correlational artifact. Overall, we conclude that β-blockers in cirrhosis are much more of a friend than enemy.
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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.