Association of non-selective β blockers with the mortality risk in decompensation cirrhosis: a systematic review and meta-analysis

Why clinicians should know about it

• Picked for Pharmacology (medical) (top studies of the week, 23 August 2026): NSBB mortality effect, dose‑response, decompensated cirrhosis

Abstract

BACKGROUND AND AIMS: The role of non-selective beta-blockers (NSBBs) in patients with decompensated cirrhosis remains controversial, with conflicting evidence regarding their safety and efficacy across different stages of disease severity. This meta-analysis aimed to evaluate the association between NSBB use and mortality in patients with decompensated cirrhosis. METHODS: We systematically searched PubMed, Embase, the Cochrane Library, and Web of Science from inception to May 2026. Studies reporting the risk of mortality associated with NSBB use in decompensated cirrhosis were included. Pooled HRs with 95% confidence intervals (CIs) were calculated using random-effects models. Subgroup analyses were performed based on mean arterial pressure (MAP), Model for End-stage Liver Disease (MELD) score, NSBB dosage, and cirrhosis complications. RESULTS: 24 studies comprising 120,072 patients were included. NSBB use was associated with a significant 25% reduction in mortality risk (HR = 0.75, 95%CI: 0.66-0.85, P < 0.01), albeit with substantial heterogeneity (I2 = 87%). The protective effect was consistent across studies employing propensity score matching (HR = 0.72, 95%CI: 0.59-0.88, P < 0.01) and multivariable regression analyses (HR = 0.74, 95%CI: 0.61-0.89, P < 0.01) by sensitivity analysis. Subgroup analyses revealed that the mortality benefit was more pronounced in patients with consistent baseline blood pressure (BP) between groups (HR = 0.82, 95%CI: 0.89-0.97), MELD score ≤15 (HR = 0.72, 95%CI: 0.56-0.92), and those receiving low-dose NSBBs (HR = 0.74, 95%CI:0.60-0.91). Conversely, NSBB use was not associated with reduced mortality in patients with inconsistent baseline BP (HR = 1.25, 95%CI: 0.52-3.00), MELD score >15 (HR = 0.92, 95%CI: 0.63-1.35), or high-dose NSBB therapy (HR = 0.92, 95%CI: 0.64-1.32). The presence of ascites, spontaneous bacterial peritonitis or hepatic encephalopathy appeared to not aggravate the survival risk. CONCLUSION: Decompensated cirrhosis should not be regarded as an absolute contraindication to NSBB therapy; rather, the decision to initiate treatment, particularly at a low dose, may be guided by MAP and MELD scores. Nonetheless, these findings require further validation through randomized controlled trials. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO, CRD420261406986.

Abstract as published, via PubMed.