S2566 Age-Dependent Mortality Impact of Nonselective Beta Blockers in Patients With Decompensated Cirrhosis

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 patients with decompensated cirrhosis based on ICD codes. Data were collected from 1/2001 to 6/2024. Patients were categorized into the following groups. Decompensated cirrhosis (30–60 years) + NSBB (carvedilol, nadolol, or propranolol); Decompensated cirrhosis (61–90 years) + NSBB; Decompensated cirrhosis (30–60 years) – NSBB; 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, and secondary outcomes included acute kidney injury (AKI), dyselectrolytemia, emergency room (ER) visits, and urgent care (UC) visits. Outcomes were assessed over 2 years following 1 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, and laboratory values (creatinine, sodium, INR, albumin, and bilirubin). Results: A total of 103,952 patients in the (61–90 years) + NSBB group and 197,942 patients in the (61–90 years) – NSBB group were identified. Following propensity score matching, each cohort included 96,084 patients. 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, and UC visits. Conclusion: 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.