25 Enthusiasm is high for these new treatments.26 There are ongoing randomized, controlled Afatinib cost trials that should help place these options in the treatment algorithm. Terlipressin is not yet available in the United States. Until further data are available, ALB, octreotide, and midodrine should be considered in the treatment of type I HRS. ALB and norepinephrine or vasopressin can be considered in the intensive care unit. Information on the use of transjugular intrahepatic stent-shunt

to treat HRS has also been updated. “
“Beta-blockers may have a negative impact on survival in patients with cirrhosis and refractory ascites. The aim of this study was to evaluate the effect of the administration of beta-blockers on long-term survival in patients with cirrhosis and refractory ascites. We performed a single-center, observational, case-only, prospective study of patients with cirrhosis and refractory ascites who did or did not receive beta-blockers for the prevention of gastrointestinal bleeding; 151 patients were included. The mean Model for End-Stage Liver Disease score was 18.8 ± selleck screening library 4.1. All patients regularly underwent large-volume paracentesis and intravenous albumin administration. Seventy-seven patients (51%) were treated with propranolol (113 ± 46 mg/day). The median follow-up for the whole group was 8 months. The median survival time was 10 months [95% confidence interval (CI) = 8-12 months]. The probability of

survival at 1 year was 41% (95% CI = 33%-49%). The clinical characteristics and laboratory values at enrolment were not significantly different between patients who were receiving propranolol and those who were not. The median survival time was 20.0 months

Celecoxib (95% CI = 4.8-35.2 months) in patients not treated with propranolol and 5.0 months (95% CI = 3.5-6.5 months) in those treated with propranolol (P = 0.0001). The 1-year probability of survival was significantly lower in patients who received propranolol [19% (95% CI = 9%-29%)] versus those who did not [64% (95% CI = 52%-76%), P < 0.0001]. The independent variables of mortality were Child-Pugh class C, hyponatremia and renal failure as causes of refractory ascites, and beta-blocker therapy. Conclusion: The use of beta-blockers is associated with poor survival in patients with refractory ascites. These results suggest that beta-blockers should be contraindicated in these patients. HEPATOLOGY 2010 Refractory ascites occurs in less than 10% of patients with cirrhosis and ascites.1 Refractory ascites is defined as a lack of response to high doses of diuretics or as the recurrence of side effects when lower doses of diuretics are given.2, 3 Patients with refractory ascites have a poor outcome.2-4 The first-line treatment for refractory ascites is repeated large-volume paracentesis.2-4 In patients with cirrhosis, the administration of nonselective beta-blockers for the prevention of gastrointestinal hemorrhaging is frequent when esophageal varices are present.