LAUSR

We read with interest the article by Ribeiro de Souza et al. addressing the impact of nonselective beta-blockers (NSBBs) on short-term prognosis in patients with cirrhosis admitted for their first episode of acute variceal bleeding (AVB). The authors adjusted their series of 49 patients on primary prophylaxis with NSBBs and 93 not on NSBBs for propensity and Model for End-Stage Liver Disease score. No influence of NSBBs used for primary prophylaxis on short-term prognosis (i.e., 5-day rebleeding and 6week mortality) was detected in patients with AVB. The message of Ribeiro de Souza et al.’s study is timely as recent publications have raised concern about the use of NSBBs for primary and secondary prophylaxis in specific clinical situations (i.e., refractory ascites). Our prospective data (January 2010-December 2015) are in line with the results of Ribeiro de Souza et al. We analyzed 106 patients with a first episode of AVB, 30 on primary prophylaxis with NSBBs (28.3%, study group) and 76 not taking NSBBs (71.7%, control group). Participants were well matched (for age, sex, etiology, previous ascites or hepatic encephalopathy, hepatocellular carcinoma, Child, and Model for End-Stage Liver Disease on admission), except for a lower heart rate in the study group (77 versus 98 bpm, P < 0.001). Rebleeding occurred in 17 of the 106 patients (16%), 2 in the study group (6.6%) and 15 in the control group (19.7%) (P 5 0.1). The odds ratio of NSBBs for bleeding was 0.3 (95% confidence interval 0.2-2.5, P 5 0.5). Fourteen of the 106 (13%) patients died during admission, 3 in the study group (10%) and 11 in the control group (14.5%) (P 5 0.5). Finally, 3 patients in the NSBB group (10%) and 15 in the control group (19.7%) died before 6 weeks (P 5 0.2). Adjusted odds ratios for in-hospital and 6-week mortality were not significantly different between the two groups: 0.5 (95% confidence interval 0.2-2.5) and 1.44 (95% confidence interval 0.1-1.7), respectively. These results reinforce the concept that variceal bleeding prophylaxis with NSBBs does not negatively affect the short-term prognosis of an AVB episode. NSBBs are the cornerstone of primary and secondary prophylaxis of variceal bleeding, and treatment with NSBBs should not be a concern if AVB arises.