Association of non-selective β blockers with the development of renal dysfunction in liver cirrhosis: a systematic review and meta-analysis

Non-selective β blockers (NSBBs) may negatively influence renal function through decreasing heart rate and cardiac output. This study aimed to systematically investigate their association. PubMed, EMBASE, and Cochrane library databases were searched to identify all relevant studies evaluating the association of NSBBs with renal dysfunction in cirrhotic patients. Unadjusted and adjusted data were separately extracted. Odds ratios (ORs) and hazard ratios (HRs) were pooled. Subgroup meta-analyses were performed according to the proportions of ascites and Child-Pugh class B/C and the mean model for end-stage liver disease (MELD) score. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework. Fourteen studies were finally included. Based on unadjusted data, NSBBs significantly increased the risk of developing renal dysfunction (OR = 1.49; <i>p</i> = 0.03), and this association remained significant in subgroup analyses of studies where the proportions of ascites was &gt;70% and Child-Pugh class B/C was 100%. Based on adjusted data with propensity score matching (adjusted OR = 0.61; <i>p</i> = 0.08) and multivariable regression modelling (adjusted HR = 0.86; <i>p</i> = 0.713), NSBBs did not increase the risk of developing renal dysfunction, and this association remained not significant in subgroup analyses of studies where the proportions of ascites was &gt;70% and &lt;70%, the proportion of Child-Pugh class B/C was &lt;100%, and the mean MELD score was &lt;15. The quality of evidence was very low for all meta-analyses. NSBBs may not be associated with the development of renal dysfunction in liver cirrhosis. However, more evidence is required to clarify their association in specific populations. Non-selective β blockers (NSBBs) may negatively influence renal function through decreasing heart rate and cardiac output in liver cirrhosis.Our meta-analysis failed to support the association of NSBBs with an increased risk of developing renal dysfunction after covariate adjustment. Non-selective β blockers (NSBBs) may negatively influence renal function through decreasing heart rate and cardiac output in liver cirrhosis. Our meta-analysis failed to support the association of NSBBs with an increased risk of developing renal dysfunction after covariate adjustment.

非选择性β受体阻滞剂（Non-selective β blockers, NSBBs）可通过降低心率与心输出量，对肝硬化患者的肾功能产生负面影响。本研究旨在系统探讨二者之间的关联。研究检索了PubMed、EMBASE及Cochrane图书馆数据库，以筛选所有评估NSBBs与肝硬化患者肾功能不全关联的相关研究。分别提取未校正与校正后的数据，合并比值比（Odds ratios, ORs）与风险比（Hazard ratios, HRs）。根据腹水占比、Child-Pugh B/C级占比以及终末期肝病模型（Model for End-stage Liver Disease, MELD）平均评分进行亚组Meta分析。采用推荐分级、评估、制定与评价（Grading of Recommendations Assessment, Development, and Evaluation, GRADE）框架对证据质量进行评估。最终纳入14项研究。基于未校正数据，NSBBs可显著升高肾功能不全的发病风险（OR=1.49；*p*=0.03），且在腹水占比＞70%、Child-Pugh B/C级占比为100%的亚组分析中，该关联仍具有统计学意义。基于倾向得分匹配（propensity score matching，校正后OR=0.61；*p*=0.08）与多变量回归模型（multivariable regression modelling，校正后HR=0.86；*p*=0.713）的校正数据，NSBBs并未升高肾功能不全的发病风险，且在腹水占比＞70%与＜70%、Child-Pugh B/C级占比＜100%、平均MELD评分＜15的亚组分析中，该关联均无统计学意义。所有Meta分析的证据质量均极低。NSBBs可能与肝硬化患者的肾功能不全发病无关联。但仍需更多证据以明确其在特定人群中的关联。非选择性β受体阻滞剂（Non-selective β blockers, NSBBs）可通过降低心率与心输出量，对肝硬化患者的肾功能产生负面影响。本Meta分析未支持协变量校正后NSBBs与肾功能不全发病风险升高的关联。非选择性β受体阻滞剂（Non-selective β blockers, NSBBs）可通过降低心率与心输出量，对肝硬化患者的肾功能产生负面影响。本Meta分析未支持协变量校正后NSBBs与肾功能不全发病风险升高的关联。