Impact of non-selective beta-blockers on acute kidney injury outcomes in patients with decompensated cirrhosis

作者：Simone Incicco, Kavish R. Patidar, Adrià Juanola, Ann T., Anna Barone, Anand V. Kulkarni, José Luis Pérez-Hernández, S G Asrani, Brian J. Wentworth, Carlo Alessandria, Nadia Abdelaaty Abdelkader, Yu Jun Wong, Qing Xie, Nikolaos Pyrsopoulos, Sung Eun Kim, Yasser Fouad, Aldo Torre, E Pichardo Reyes, Javier Diaz-Ferrer, Rakhi Maiwall, Douglas A. Simonetto, Mária Papp, Eric S. Orman, Giovanni Perricone, Cristina Solé, C M Lange, Alberto Queiróz Farias, Gustavo Pereira, Sebastián Marciano, Paolo Caraceni, Thierry Thévenot, Nipun Verma, Jeong Han Kim, Julio D. Vorobioff, Jacqueline Córdova‐Gallardo, Vasilisa R. Greshnikova, Raoel Maan, Juan Pablo Roblero, Claudio Toledo, Stefania Gioia, E Fassio, Mónica Marino, Puria Nabilou, Vı́ctor Vargas, Manuela Merli, Luciana Lofêgo Gonçalves, Liane Rabinowich, Aleksander Krag, Lorenz Balcar, Adrian Gadano, François Durand, S M Sarin, Pere Ginès, Paolo Angeli, Elsa Solà, Salvatore Piano, P.N. Rao, Mithun Sharma, Luis Garrido-Trevino, Kim Minh Le, Dong Joon Kim, Ji Won Park, Rahul Kumar, Jessica Tan Yi-Lyn, Diego Fernando Abendaño Rivera, Karina Cazarin Chávez, Maria José Moreta, Alberto Calleri, Marco Tizzani, Nicolas M. Intagliata, Gabrielle Laskey, Luca Saverio Belli, Enrico Pompili, Marco Mattana, Safaa M. Abdelhalim, Caroline Marcondes Ferreira, Kamalpreet S. Hara, Paul Jamme, Maria Grazia Cortese, Daniela Simian, Won-hyeok Choe, Stefanny Cornejo-Hernández, César Jiménez, Juliana Piedade, Mariana Ariel Herrera Islas, Silvina Tevez, Izabelle Venturini Signorelli, Zuly Plácido-Damián, Jesús Ruiz-Manríquez, Enas Mohamed Soliman, Cecilia Barreda Sánchez, Zhujun Cao, Yaoxing Chen, Berta López‐Sáez, Renato Palma-Fernández, Boglarka Balogh, Lise Lotte Gluud, Ivan Bello, Delphine Weil-Verhoeven, Silvia Nardelli, Marina Maevskaya, Arka De, Adrian Gadano, Pedro Montes, Ângelo Mattos, Tony Bruns, Abdulsemed Mohammed, Wim Laleman, Enrique Carrera, María Cecilia Cabrera, Marcos Girala, Hrishikesh Samant, Sarah Raevens, Joao Madaleno, Ray W. Kim, Juan Pablo ArabJosé Presa, Carlos Noronha Ferreira, Antonio Galante, Andrew S. Allegretti, B. Takkenberg, Olivier Roux, Murat Harputluoğlu, Andrea De Gottardi, Thomas Reiberger · 发表于：Journal of Hepatology · 年份：2026 · DOI：10.1016/j.jhep.2026.06.043 · 研究领域：Liver Disease and Transplantation、Acute Kidney Injury Research、Hepatocellular Carcinoma Treatment and Prognosis

BACKGROUND & AIMS: Non-selective beta-blockers (NSBBs) are widely used to prevent decompensation in cirrhosis. Guidelines recommend discontinuing NSBBs in patients with cirrhosis and acute kidney injury (AKI), although this recommendation is based largely on expert opinion and limited evidence. We evaluated the impact of NSBB use on AKI outcomes in patients with cirrhosis. METHODS: This multicenter study enrolled patients hospitalized for decompensated cirrhosis and AKI. Data on NSBB treatment, including type, dose, and continuation, discontinuation, or tapering, were collected. Outcomes were compared between patients receiving and not receiving NSBBs and between those who discontinued/tapered and those who did not. Inverse probability of treatment weighting (IPTW) was used to balance demographics, liver disease severity, hemodynamic parameters, AKI stage and acute-on-chronic liver failure (ACLF) grade. The main outcomes were AKI resolution and 28-day mortality. RESULTS: Of 1,238 patients with AKI, 503 were on NSBBs (propranolol 55%; carvedilol 45%). After IPTW adjustment, NSBB treatment at AKI diagnosis was associated with higher likelihood of AKI resolution (subdistribution hazard ratio [sHR] 1.29; 95% CI 1.12-1.48; p <0.001) and reduced 28-day mortality (sHR 0.70; 95% CI 0.55-0.91; p = 0.006). At 48-72 hours from AKI diagnosis, NSBBs were continued in 122 patients (24%) and discontinued/tapered in 349 (69%); 4 patients died, and data were not available for the remaining 28...