Non-selective beta-blockers reduce mortality risk by 25% in patients with decompensated cirrhosisBeta Blockers May Reduce Mortality Risk in Cirrhosis Patients

Background and AimsThe role of non-selective beta-blockers (NSBBs) in patients with decompensated cirrhosis remains controversial, with conflicting evidence regarding their safety and efficacy across different stages of disease severity. This meta-analysis aimed to evaluate the association between NSBB use and mortality in patients with decompensated cirrhosis.MethodsWe systematically searched PubMed, Embase, the Cochrane Library, and Web of Science from inception to May 2026. Studies reporting the risk of mortality associated with NSBB use in decompensated cirrhosis were included. Pooled HRs with 95% confidence intervals (CIs) were calculated using random-effects models. Subgroup analyses were performed based on mean arterial pressure (MAP), Model for End-stage Liver Disease (MELD) score, NSBB dosage, and cirrhosis complications.Results24 studies comprising 120,072 patients were included. NSBB use was associated with a significant 25% reduction in mortality risk (HR = 0.75, 95%CI: 0.66–0.85, P < 0.01), albeit with substantial heterogeneity (I2 = 87%). The protective effect was consistent across studies employing propensity score matching (HR = 0.72, 95%CI: 0.59–0.88, P < 0.01) and multivariable regression analyses (HR = 0.74, 95%CI: 0.61–0.89, P < 0.01) by sensitivity analysis. Subgroup analyses revealed that the mortality benefit was more pronounced in patients with consistent baseline blood pressure (BP) between groups (HR = 0.82, 95%CI: 0.89–0.97), MELD score ≤15 (HR = 0.72, 95%CI: 0.56–0.92), and those receiving low-dose NSBBs (HR = 0.74, 95%CI:0.60–0.91). Conversely, NSBB use was not associated with reduced mortality in patients with inconsistent baseline BP (HR = 1.25, 95%CI: 0.52–3.00), MELD score >15 (HR = 0.92, 95%CI: 0.63–1.35), or high-dose NSBB therapy (HR = 0.92, 95%CI: 0.64–1.32). The presence of ascites, spontaneous bacterial peritonitis or hepatic encephalopathy appeared to not aggravate the survival risk.ConclusionDecompensated cirrhosis should not be regarded as an absolute contraindication to NSBB therapy; rather, the decision to initiate treatment, particularly at a low dose, may be guided by MAP and MELD scores. Nonetheless, these findings require further validation through randomized controlled trials.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO, CRD420261406986.