Assessing the safety of beta‐blocker therapy in cirrhosis patients with ascites: A meta‐analysis
Bibliographic record
Abstract
Abstract Background & Aims Beta‐blocker therapy is effective at reducing risks of variceal bleeding. However, beta‐blockers may detrimentally exacerbate the underlying haemodynamic changes in cirrhosis. A systematic review and meta‐analysis was performed to evaluate impact of beta‐blockers on all‐cause mortality among cirrhosis patients with ascites. Methods A literature search identified studies that evaluated beta‐blocker vs no beta‐blocker therapy in cirrhosis patients with ascites. The primary outcome was all‐cause mortality with subcohort analysis of patients with refractory or severe ascites. Quality of observational studies was assessed with Newcastle‐Ottawa Scale and overall certainty of the evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results Eight observational studies, representing 3627 cirrhosis patients with ascites (1630 treated with beta‐blockers and 1997 not treated), were included. Pooled all‐cause mortality was 38.6% in beta‐blocker group vs 42.2% in no beta‐blocker group (RR 0.93, 95% CI 0.77‐1.13, χ 2 = 54.03, I 2 = 87%). Subcohort analysis of cirrhosis patients with refractory or severe ascites demonstrated 33.3% mortality in beta‐blocker group vs 32.1% in no beta‐blocker group (RR 0.99, 95% CI 0.70‐1.40, χ 2 = 32.99, and I 2 = 82%). Three studies were good quality and five studies were fair quality. GRADE rating was ‘very low’ certainty of evidence, given concern for bias and inconsistency stemming from significant heterogeneity. Conclusion No significant increase in all‐cause mortality was observed in cirrhosis patients with ascites treated with beta‐blockers. However, given the low certainty of the evidence, high quality prospective studies are needed.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".