Efficacy of non-selective beta blockers in the treatment of acute-on-chronic liver failure: a systematic review and meta-analysis

Why clinicians should know about it

• Picked for Epidemiology (paper of the day, 9 October 2026): Meta‑analysis of observational studies on NSBBs in ACLF

Abstract

INTRODUCTION AND OBJECTIVES: Non-selective beta blockers (NSBBs) are beneficial for people with chronic liver diseases by reducing portal pressure. However, the benefit of NSBB treatment in patients with acute-on-chronic liver failure (ACLF) remains controversial. This systematic review and meta-analysis aimed to explore the efficacy of NSBBs in ACLF patients. MATERIALS AND METHODS: A systematic search was conducted in PubMed, EMBASE, Web of Science, and Cochrane Library databases up to December 5, 2025. The quality of the included studies was assessed using the revised Cochrane Collaboration Risk of Bias Tool for randomized controlled trials and the Newcastle-Ottawa scale for cohort studies. Effect estimates were reported as risk ratio (RR) with 95% confidence interval (CI). The primary outcome was overall mortality, while secondary outcomes were 1-month, 3-month, and 12-month mortality. RESULTS: Of the 2007 articles identified, six articles were included. The pooled mortality was 48.9% in the NSBB group compared to 67.4% in the non-NSBB group (RR = 0.81, 95% CI: 0.73-0.91, p<0.01, I2 = 27%). One-month mortality (RR = 0.66, 95%CI: 0.52-0.84; p<0.01), 3-month mortality (RR = 0.87, 95%CI: 0.77-0.97; p = 0.01), and 12-month mortality (RR = 0.84, 95%CI: 0.75-0.93; p<0.01) in the NSBB group were significantly lower than those in the non-NSBB group. CONCLUSIONS: This meta-analysis demonstrates that NSBBs are associated with improvement in the short term (1-month) and 1-year survival outcomes in patients with ACLF. However, further studies with more evidence are required to support these findings.

Abstract as published, via PubMed.