Preprint Article Version 1 This version is not peer-reviewed

Propranolol Treatment is Associated with Better Survival in Cirrhotic Patients with Hepatic Encephalopathy

Version 1 : Received: 22 December 2018 / Approved: 24 December 2018 / Online: 24 December 2018 (12:41:29 CET)

How to cite: Lee, P.L.; Chen, Y.; Cho, Y.; Lee, K.; Chen, P.; Kao, W.; Huang, Y.; Huo, T.; Lin, H.; Hou, M.; Lee, F.; Wu, J.; Su, C. Propranolol Treatment is Associated with Better Survival in Cirrhotic Patients with Hepatic Encephalopathy. Preprints 2018, 2018120278 (doi: 10.20944/preprints201812.0278.v1). Lee, P.L.; Chen, Y.; Cho, Y.; Lee, K.; Chen, P.; Kao, W.; Huang, Y.; Huo, T.; Lin, H.; Hou, M.; Lee, F.; Wu, J.; Su, C. Propranolol Treatment is Associated with Better Survival in Cirrhotic Patients with Hepatic Encephalopathy. Preprints 2018, 2018120278 (doi: 10.20944/preprints201812.0278.v1).

Abstract

Hepatic encephalopathy (HE) reduces survival in cirrhotic patients and correlates with systemic inflammation and gut-liver disequilibrium. We investigated the association between propranolol treatment and outcomes for cirrhotic patients with HE. Using data from the Taiwan National Health Insurance Research Database, we identified 4,754 cirrhotic patients newly diagnosed with HE. Among them, 519 patients received propranolol treatment and the other 519 patients without exposure to propranolol were enrolled into our study, both of which were matched by sex, age, and propensity score. The median overall survival (OS) was longer in the propranolol-treated cohort than in the untreated cohort (3.46 versus 1.88 years, p<0.001). A dose-dependent increase in survival was observed (median OS: 4.49, 3.29, and 2.46 years in patients treated with propranolol >30mg/day, 20–30mg/day, and <20mg/day, respectively [p<0.001, p=0.001, and p=0.079 versus the untreated group]). In addition to reduce the risk of mortality (adjusted hazard ratio, 0.58; p<0.001), propranolol also diminished the risk of sepsis-related death (adjusted hazard ratio, 0.31; p=0.006) according to the multivariate analysis. However, the risk of circulatory or hepatic failure was non-significantly altered by propranolol treatment. In conclusion, propranolol treatment was associated with a better OS in cirrhotic patients with HE and its effects were dose-dependent.

Subject Areas

Cirrhosis; Hepatic encephalopathy; Propranolol; Prognosis

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