P3652 - Age-Dependent Mortality Impact of Nonselective Beta Blockers in Patients With Decompensated Cirrhosis

Ahmad Nawaz, MBBS¹, Avneet Kaur, MBBS², Abdelkader Chaar, MD¹, Ganesh Aswath, MD², Idan Goren, MD¹, Savio John, MD, FACG¹
1SUNY Upstate Medical University, Syracuse, NY; 2SUNY Upstate Medical University Hospital, Syracuse, NY

Introduction: There is limited data regarding the use of nonselective beta blockers (NSBB) in older adults with decompensated cirrhosis.

Methods: Using the TriNetX database, we identified pts with decompensated cirrhosis based on ICD codes. Data were collected from 1/2001 to 6/2024. Patients were categorized into the following groups.
1. Decompensated cirrhosis (30–60 years) + NSBB (carvedilol, nadolol, or propranolol)
2. Decompensated cirrhosis (61–90 years) + NSBB
3. Decompensated cirrhosis (30–60 years) – NSBB
4. Decompensated cirrhosis (61–90 years) – NSBB

Outcomes were compared between age-matched and NSBB groups: (30–60 years) + NSBB vs. (30–60 years) – NSBB, and (61–90 years) + NSBB vs. (61–90 years) – NSBB. Primary outcome was mortality, & secondary outcomes included acute kidney injury (AKI), dyselectrolytemia, emergency room (ER) visits, and urgent care (UC) visits. Outcomes were assessed over two years following one month of NSBB initiation. A subgroup analysis was performed comparing (81–90 years) + NSBB with (81–90 years) – NSBB.

Propensity score matching (1:1) was applied based on demographics, comorbidities, & laboratory values (creatinine, sodium, INR, albumin, & bilirubin).

Results: A total of 103,952 patients in the (61–90 years) + NSBB group and 197,942 pts in the (61–90 years) – NSBB group were identified. Following propensity score matching, each cohort included 96,084 pts. Mortality did not significantly differ between the groups. However, patients in the (61–90 years) + NSBB group had higher rates of AKI [OR 1.39, 95% CI 1.36–1.42], hypernatremia [OR 1.24, 95% CI 1.18–1.32], hypokalemia [OR 1.11, 95% CI 1.08–1.15], hyperkalemia [OR 1.52, 95% CI 1.47–1.56], ER visits [OR 1.27, 95% CI 1.25–1.30], and UC visits [OR 1.33, 95% CI 1.31–1.36].

In the subgroup analysis, the (81–90 years) + NSBB cohort had increased mortality compared to the (81–90 years) – NSBB cohort [OR 1.10, 95% CI 1.02–1.18]. Conversely, the (30–60 years) + NSBB cohort demonstrated reduced mortality compared to the (30–60 years) – NSBB cohort [OR 0.86, 95% CI 0.80–0.92], though with increased rates of AKI, hyperkalemia, ER visits, & UC visits.

Discussion: In a propensity-matched analysis, NSBB use in patients aged 30–60 years with decompensated cirrhosis was associated with reduced mortality compared to non-NSBB users. However, no significant mortality difference was observed among older adults (61–90 years). Notably, increased mortality was identified in patients aged 81–90 years on NSBB compared to non-NSBB users.

Disclosures:
Ahmad Nawaz indicated no relevant financial relationships.
Avneet Kaur indicated no relevant financial relationships.
Abdelkader Chaar indicated no relevant financial relationships.
Ganesh Aswath indicated no relevant financial relationships.
Idan Goren indicated no relevant financial relationships.
Savio John indicated no relevant financial relationships.

Ahmad Nawaz, MBBS¹, Avneet Kaur, MBBS², Abdelkader Chaar, MD¹, Ganesh Aswath, MD², Idan Goren, MD¹, Savio John, MD, FACG¹. P3652 - Age-Dependent Mortality Impact of Nonselective Beta Blockers in Patients With Decompensated Cirrhosis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.