The use of beta‐blockers is associated with the occurrence of acute kidney injury in severe alcoholic hepatitis

Background & Aims The beneficial effect of nonselective beta‐blockers ( NSBB ) has recently been questioned in patients with end‐stage cirrhosis. We analysed the impact of NSBB on outcomes in severe alcoholic hepatitis ( AH ). Methods This study was based on a prospective database of patients with severe, biopsy‐proven AH . Patients admitted from July, 2006 to July, 2014 were retrospectively studied. Patients were divided into two groups (with and without NSBB ) and assessed for the occurrence of Acute Kidney Injury ( AKI ) and transplant‐free mortality during a 168‐day follow‐up period. Results One hundred thirty‐nine patients were included, the mean Maddrey score was 71 ± 34 and 86 patients (61.9%) developed AKI . Forty‐eight patients (34.5%) received NSBB . The overall 168‐day transplant‐free mortality was 50.5% (95% CI , 41.3–60.0%). The overall 168‐day cumulative incidence of AKI was 61.9% (95% CI , 53.2–69.4%). When compared, patients with NSBB had a lower heart rate (65 ± 13 vs 92 ± 12, P  < 0.0001) and a lower mean arterial pressure ( MAP , 78 ± 3 vs 87 ± 5, P  < 0.0001). Patients with NSBB had comparable MELD scores, Maddrey scores, and medical histories. The 168‐day transplant‐free mortality was 56.8% (95% CI , 41.3–69.7%) in patients with NSBB and 46.7% (95% CI , 35.0–57.6%) without NSBB ( P  = 0.25). The 168‐day cumulative incidence of AKI was 89.6% (95% CI , 74.9–95.9%) with NSBB compared to 50.4% (95% CI : 39.0–60.7) for no NSBB ( P  = 0.0001). The independent factors predicting AKI were a higher MELD score and the presence of NSBB . Conclusions The use of NSBB in patients with severe AH is independently associated with a higher cumulative incidence of AKI .