Beta blocker therapy seems to reduce systemic inflammation in cirrhotic patients with portal hypertension - a paired HVPG study

Background and Aims Non-selective beta-blockers (NSBBs) decrease portal pressure - as clinically assessed by measurement of the hepatic venous pressure gradient (HVPG). NSBBs may also exert anti-inflammatory activity.

Method We assessed markers of systemic inflammation (WBC, CRP, IL-6, PCT) at sequential HVPG measurements, i.e. without NSBB at baseline and with NSBB at follow-up. The impact of NSBB on these biomarkers was evaluated by paired analyses stratified by Child-Turcotte-Pugh stage (CTP) and HVPG-response (≥ 20 % relative decrease/decrease to an absolute value of  < 12mmHg).

Results 307 patients were included: median age: 55 years; CTP-A = 82 (26.7 %), B = 163 (53.1 %), C = 62 (20.2 %). 107 patients achieved HVPG-response (34.9 %). NSBB therapy resulted in a significant decrease of WBC (median: -2 %; median 4.78 [IQR 3.12] to 4.65 [2.95] G/L; p = 0.011), and of CRP levels (-14 %; 0.48 [0.99] to 0.35 [0.72] mg/dL; p  <  0.001), while overall no significant effects were observed on IL-6 (10.83 [17.16] to 12.27 [15.06] pg/mL; p = 0.578) and PCT (0.13 [0.14] to 0.11 [0.10] ng/mL; p = 0.292). CTP-C patients showed the most pronounced reductions in WBC (-16 %; 5.87 [4.14] to 5.09 [2.78] G/L; p  <  0.001), CRP (-26 %; 1.34 [1.89] to 0.92 [1.31] mg/L; p = 0.007), and PCT levels (-17 %; 0.20 [0.07] to 0.15 [0.08] ng/mL; p = 0.022). HVPG responders showed significantly stronger decreases of WBC (-7 %; 5.01 [3.12] to 4.67 [3.13] G/L vs.  ± 0 %; 4.53 [2.96] to 4.60 [2.77] G/L; p = 0.008) but similar decreases of CRP (-17 %; 0.48 [1.33] to 0.35 [0.82] mg/dL vs. -13 %; 0.49 [0.82] to 0.35 [0.58] mg/dL; p = 0.574), as compared to HVPG non-responders.

Conclusion NSBB therapy seems to exert systemic anti-inflammatory activity as evidenced by reductions of WBC and CRP levels. Interestingly, this effect was most pronounced in CTP-C patients and HVPG-responders. The potential impact on outcomes should be further investigated.

Publication History

Article published online:
26 May 2020