Age-Stratified Mortality Outcomes Associated with Nonselective Beta-Blocker Use in Patients with Decompensated Cirrhosis.

Background/Objectives: Nonselective beta blockers (NSBBs) are widely used in cirrhosis for portal hypertension, but their safety in older adults with decompensated cirrhosis remains uncertain. Methods: We conducted a retrospective multicenter cohort study using the TriNetX Research Network. Adults aged 30-90 years with decompensated cirrhosis were stratified into three groups: 30-60 years, 61-90 years, and a prespecified subgroup of 81-90 years. NSBB exposure (propranolol, nadolol, or carvedilol) within 30 days of decompensation was assessed, and 1:1 propensity score matching was performed within each age group. The primary outcome was 12-month all-cause mortality. Secondary outcomes included acute kidney injury (AKI), electrolyte abnormalities, and acute care utilization. Results: After matching, 40,074 pairs (30-60 years), 96,084 pairs (61-90 years), and 19,024 pairs (81-90 years) were analyzed. NSBB use was associated with lower 12-month mortality in ages 30-60 (4.0% vs. 4.6%; RR 0.86, 95% confidence interval [CI] 0.81-0.92). 61-90-year cohort, mortality was similar between groups (7.4% vs. 7.4%; RR 0.99, 95% CI 0.96-1.02). Patients aged 81-90 years, NSBB use was associated with higher mortality (10.9% vs. 10.0%; RR 1.08, 95% CI 1.02-1.16). Across age strata, NSBB was associated with increased AKI, hyperkalemia, and acute care visits. Conclusions: NSBB therapy was associated with reduced mortality in younger adults (30-60 years) but not in older patients (61-90 years) and was associated with increased mortality among those aged 81-90 years. These findings support individualized NSBB use and suggest that patient age should be considered when weighing potential benefits and risks.