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Non-selective beta-blocker use in cirrhosis: the additional benefit in preventing secondary infections
  1. Rooshi Nathwani1,2,
  2. David Kockerling1,2,
  3. Benjamin H Mullish1,2,
  4. Alexander Cole1,2,
  5. Maud Lemoine1,2,
  6. Charalambos Gustav Antoniades1,2,
  7. Mark R Thursz1,2,
  8. Ameet Dhar1,2
  1. 1 Division of Digestive Diseases, Imperial College London, London, UK
  2. 2 Department of Metabolism, Digestion and Reproduction, Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to Dr Rooshi Nathwani, Division of Metabolism, Digestion and Reproduction, Imperial College London, London W2 1NY, UK; rooshi.nathwani08{at}

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We read with interest the work by Jachs et al, reporting the benefits of non-selective beta blockers (NSBBs) in reducing systemic inflammation in individuals with cirrhosis, with an associated reduced rate of acute decompensation and mortality.1 Systemic inflammation is a hallmark of cirrhosis-associated immune dysfunction, representing pathological translocation of bacteria and/or bacterial products from the gut.2

Cirrhotics have an increased risk of developing infection,3 with substantially increased mortality when such infections occur.4 5 Secondary infections significantly contribute to this, and predict 30-day mortality independently of disease severity.6 7 Extending on the work of Jachs et al, we here report a beneficial impact of NSBB on clinical and microbiological outcomes of decompensated cirrhotics in both a specialist outpatient setting and inpatients. We also report the novel finding of a reduction in circulating bacterial DNA (bDNA) levels in a subset of cirrhotics with primary infections on NSBB.

We retrospectively analysed 138 patients with Child-Pugh grade B/C cirrhosis attending a specialist cirrhosis outpatient clinic at St Mary’s Hospital, London, over a 2-year period. Patients were included at the point of clinic attendance, with records …

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  • Twitter @RooshiNathwani, @bhmullish

  • Contributors RN: lead author of the manuscript, involved with data collection, analysis and experimental work. DK and BM: data collection and manuscript write-up. AC: data collection. ML, CGA, MRT and AD: conceptualised the work, provided intellectual support and edited the manuscript. AD: overall responsibility for the carried out work. All authors reviewed and approved the final version of the manuscript.

  • Funding The Division receives financial support from the National Institute of Health Research (NIHR) Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London. BHM is the recipient of an NIHR Academic Clinical Lectureship (CL-2019-21-002).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.