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Metabolic co\u2010morbidities (MetC) are increasingly observed in cACLD patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To investigate the impact of MetC on the haemodynamic effects of NSBB and hepatic decompensation in cACLD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>cACLD patients undergoing paired hepatic venous pressure gradient (HVPG) measurements before\/under NSBB therapy were retrospectively considered for this study. We recorded baseline characteristics on MetC (obesity, dyslipidaemia and diabetes), as well as hepatic decompensation and liver\u2010related mortality during follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 92 patients (Child\u2010A <jats:italic>n<\/jats:italic>\u2009=\u200980, 87%; Child\u2010B <jats:italic>n<\/jats:italic>\u2009=\u200912, 13%). MetC were found in 34 (37%) patients: 19 (20.7%) with obesity, 14 (15.2%) with dyslipidaemia and\u200923 (34.8%) with diabetes. The median baseline HVPG of 18 (IQR:15\u201321) mmHg decreased to 15 (IQR:9\u201312) mmHg under NSBB. HVPG\u2010response (decrease \u226510% or to \u226412\u2009mmHg) was achieved in 60 (65.2.%) patients. Patients with diabetes (OR: 0.35, <jats:italic>p<\/jats:italic>\u2009=\u20090.021) and higher BMI (OR: 0.89 per kg\/m<jats:sup>2<\/jats:sup>, <jats:italic>p<\/jats:italic>\u2009=\u20090.031) were less likely to achieve HVPG\u2010response.<\/jats:p><jats:p>During a median follow\u2010up of 2.3 (0.5\u20134.2) years, 18 (19.5%) patients experienced hepatic decompensation. Child\u2010B (adjusted subdistribution hazard ratio, aSHR: 4.3 [95% CI:1.5\u201312.2], <jats:italic>p<\/jats:italic>\u2009=\u20090.006), HVPG\u2010response (aSHR: 0.3 [95% CI:0.1\u20130.9], <jats:italic>p<\/jats:italic>\u2009=\u20090.037) and diabetes (aSHR: 2.8 [95% CI:1.1\u20137.2], <jats:italic>p<\/jats:italic>\u2009=\u20090.036) were independently associated with hepatic decompensation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In patients with cACLD, diabetes and a higher BMI impair the HVPG\u2010response to NSBB. Furthermore, diabetes\u2010independently from Child B and lack of HVPG\u2010response\u2010increases the risk of\u00a0hepatic decompensation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.17653","type":"journal-article","created":{"date-parts":[[2023,7,31]],"date-time":"2023-07-31T03:13:56Z","timestamp":1690773236000},"page":"805-813","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Diabetes impairs the haemodynamic response to non\u2010selective betablockers in compensated cirrhosis and predisposes to hepatic decompensation"],"prefix":"10.1111","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1813-5769","authenticated-orcid":false,"given":"Rafael","family":"Paternostro","sequence":"first","affiliation":[{"name":"Divison of Gastroenterology and Hepatology, Department of Internal Medicine III Medical University of Vienna  Vienna Austria"},{"name":"Vienna Hepatic Hemodynamic Laboratory, Division of 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