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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 of …
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.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; internally peer reviewed.
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