Non-selective beta blockers in cirrhosis: time to extend the indications?

In a cirrhotic patient, irrespective of etiology, the index decompensation represents a critical landmark in their disease progression. Life expectancy plummets with 2-year survival as low as 50% after the development of ascites, which also happens to be the most common decompensating event (1). It is imperative that liver transplantation becomes a therapeutic consideration at this point, however liver transplantation is not without its own morbidity and mortality. It is thereby of vast importance to prevent index decompensation in patients with compensated cirrhosis. A recent paper published in The Lancet, the “PREDESCI” trial, describes work done by a Spanish group which reports the results of a randomised and controlled clinical trial of non-selective beta blockers (NSBB) in preventing or delaying index decompensation (2). Decompensation was defined as the development of ascites (grade 2 or 3), bleeding related to portal hypertension, and hepatic encephalopathy