Impatto dei beta bloccanti non selettivi sugli esiti del danno renale acuto nei pazienti con cirrosi epatica scompensata

Background and aims: Non-selective beta-blockers (NSBB) are widely used to prevent decompensation in patients with cirrhosis. Current guidelines recommend discontinuing NSBB in patients with cirrhosis and acute kidney injury (AKI), although this recommendation is based largely on expert opinion and limited evidence. Therefore, we evaluated the impact of NSBB on AKI outcomes in patients with acutely decompensated cirrhosis. Methods: This is a multicenter study that enrolled patients hospitalized for acute decompensation (AD) of cirrhosis. Data on NSBB treatment, type (propranolol vs carvedilol) and dose at AKI diagnosis as well as data on their management during hospitalization (continuation at the same dose vs tapering/discontinuation) were collected. AKI outcomes were compared between patients receiving and not receiving NSBB at the time of AKI diagnosis as well as between those who discontinued/tapered and those who did not. Propensity score matching (PSM, 1:1 ratio) was used to balance demographics (age, sex), liver disease severity (MELD-Na score), hemodynamic parameters (mean arterial pressure, MAP), AKI stage and acute-on-chronic liver failure (ACLF) grade. Main outcomes were AKI resolution and 28-day mortality. Results: Out of 1,238 patients with AKI, 503 were on NSBB (propranolol 55%; carvedilol 45%), mostly at low doses (<80 mg/day of propranolol and ≤12,5 mg/day of carvedilol), at the time of AKI diagnosis. After PSM, all covariates were balanced. Patients on NSBB had lower white blood cells count (7.38 vs 9.20 x109/L; p<0.001). NSBB treatment at AKI diagnosis was associated with higher likelihood of AKI resolution (OR=1.54; 95% CI=1.19 – 2.00; p=0.001) and reduced 28-day mortality (sHR=0.68; 95% CI=0.52 – 0.89; p=0.005). During hospitalization, NSBB were continued at the same dose in 123 patients (24%) and discontinued/tapered in 350 (70%). Data about NSBB management during hospitalization were missing in the remaining 30 patients (6%) who were excluded from further analysis. After PSM, continuation of NSBB was neither associated with AKI resolution (OR=1.00; 95% CI=0.56 – 1.79; p=0.999) nor with 28-day mortality (sHR=0.56; 95% CI=0.24 – 1.34; p=0.190). Conclusion: NSBB treatment at AKI diagnosis is associated with improved renal recovery and survival in patients with acutely decompensated cirrhosis and AKI. NSBB continuation during hospitalization does not appear harmful, supporting careful individualized management rather than systematic withdrawal.