Impact of concomitant cardiovascular medications on overall survival in patients with liver cirrhosis

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Moying Li - , Heidelberg University  (Author)
  • Timo Itzel - , Heidelberg University  (Author)
  • Nathally Espinosa Montagut - , Universidad de los Andes Colombia (Author)
  • Thomas Falconer - , Columbia University Irving Medical Center (CUMC) (Author)
  • Jimmy Daza - , Heidelberg University  (Author)
  • Jimyung Park - , Ajou University (Author)
  • Jae Youn Cheong - , Ajou University (Author)
  • Rae Woong Park - , Ajou University (Author)
  • Isabella Wiest - , Heidelberg University  (Author)
  • Matthias Philip Ebert - , Heidelberg University  (Author)
  • George Hripcsak - , Columbia University Irving Medical Center (CUMC) (Author)
  • Andreas Teufel - , Heidelberg University  (Author)

Abstract

Objectives of the article: Liver cirrhosis is the end-stage liver disease associated with poor prognosis and cardiovascular comorbidity could significantly impact mortality of cirrhotic patients. We conducted a large, retrospective study to investigate the survival impact of cardiovascular co-medications in patients with liver cirrhosis. Materials and methods: A study-specific R package was processed on the local databases of partner institutions within the Observational Health Data Sciences and Informatics consortium, namely Columbia University, New York City (NYC), USA and Ajou University School of Medicine (AUSOM), South Korea. Patients with cirrhosis diagnosed between 2000 and 2020 were included. Final analysis of the anonymous survival data was performed at Medical Faculty Mannheim, Heidelberg University. Results: We investigated a total of 32,366 patients with liver cirrhosis. Our data showed that administration of antiarrhythmics amiodarone or digoxin presented as a negative prognostic indicator (p = 0.000 in both cohorts). Improved survival was associated with angiotensin-converting enzyme inhibitor ramipril (p = 0.005 in NYC cohort, p = 0.075 in AUSOM cohort) and angiotensin II receptor blocker losartan (p = 0.000 in NYC cohort, p = 0.005 in AUSOM cohort). Non-selective beta blocker carvedilol was associated with a survival advantage in the NYC (p = 0.000) cohort but not in the AUSOM cohort (p = 0.142). Patients who took platelet inhibitor clopidogrel had a prolonged overall survival compared to those without (p = 0.000 in NYC cohort, p = 0.003 in AUSOM cohort). Conclusion: Concomitant cardiovascular medications are associated with distinct survival difference in cirrhotic patients. Multidisciplinary management is needed for a judicious choice of proper cardiovascular co-medications in cirrhotic patients.

Details

Original languageEnglish
Pages (from-to)1505-1513
Number of pages9
JournalScandinavian journal of gastroenterology
Volume58
Issue number12
Publication statusPublished - 2023
Peer-reviewedYes
Externally publishedYes

External IDs

PubMed 37608699

Keywords

ASJC Scopus subject areas

Keywords

  • cardiovascular co-medication, comorbidities, Liver cirrhosis, multidisciplinary management, overall survival