This multicenter prospective cohort study evaluated the impact of non-selective beta-blockers (NSBB) on AKI resolution and 28-day mortality in 1,238 hospitalized patients with acutely decompensated cirrhosis and AKI, using inverse probability of treatment weighting (IPTW) to adjust for confounders.
NSBB use at AKI diagnosis was associated with greater AKI resolution (sHR=1.29, 95% CI 1.12–1.48, p<0.001) and lower 28-day mortality (sHR=0.70, 95% CI 0.55–0.91, p=0.006). Early NSBB discontinuation/tapering (69% of NSBB patients) showed no significant benefit over continuation for either AKI resolution (sHR=0.84, p=0.391) or 28-day mortality (sHR=0.51, p=0.089).
- Observational design limits causal inference despite IPTW adjustment. - Nearly 70% of NSBB patients had their drugs discontinued/tapered, with continuation decisions left to clinician discretion, introducing selection bias. - Missing outcome data in 28 patients and exclusion of 59 patients where continuation was not feasible may affect generalizability.
Do not reflexively stop NSBBs when a cirrhotic patient develops AKI — current data suggest NSBB use at AKI onset is associated with better outcomes, and continuation does not appear harmful. A personalized, case-by-case approach to NSBB management is more appropriate than routine withdrawal.
