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High‐dose proton pump inhibitor treatment is associated with a higher mortality in cirrhotic patients: A multicentre study

医学 肝肾综合征 质子抑制剂泵 自发性细菌性腹膜炎 倾向得分匹配 置信区间 肝性脑病 内科学 回顾性队列研究 肝硬化 胃肠病学
作者
Jun Sik Yoon,Ji Hoon Hong,Soo Young Park,Seung Up Kim,Hwi Young Kim,Ju Yeon Kim,Moon Haeng Hur,Min Kyung Park,Yun Bin Lee,Han Ah Lee,Gi‐Ae Kim,Dong Hyun Sinn,Sung Jae Park,Youn Jae Lee,Yoon Jun Kim,Jung‐Hwan Yoon,Jeong‐Hoon Lee
出处
期刊:Alimentary Pharmacology & Therapeutics [Wiley]
卷期号:59 (8): 973-983 被引量:4
标识
DOI:10.1111/apt.17909
摘要

Summary Background Proton pump inhibitors (PPI) are frequently used in patients with cirrhosis. Aims This study aimed to determine whether PPI use is associated with the prognosis of cirrhotic patients. Methods We conducted a multicentre retrospective cohort study involving 1485 patients who had experienced hepatic encephalopathy (HE) from 7 referral centres in Korea. The primary outcome was overall survival and secondary outcomes included the development of cirrhotic complications, including recurrent HE, spontaneous bacterial peritonitis (SBP), hepatorenal syndrome (HRS), and gastrointestinal bleeding. Patients treated with PPI with a mean defined daily dose (mDDD) ≥0.5 (high‐dose PPI group) were compared to those treated with PPI of an mDDD < 0.5 (No or low‐dose PPI group) for each outcome. Results Among 1485 patients (median age, 61 years; male, 61%), 232 were assigned to the high‐dose PPI group. High‐dose PPI use was independently associated with a higher risk of death (adjusted HR [aHR] = 1.71, 95% confidence interval [CI] = 1.38–2.11, p < 0.001). This result was reproducible after propensity score‐matching (PSM) (aHR = 1.90, 95% CI = 1.49–2.44, p < 0.001). High‐dose PPI use was an independent risk factor of recurrent HE (before PSM: aHR = 2.04, 95% CI = 1.66–2.51, p < 0.001; after PSM: aHR = 2.16, 95% CI = 1.70–2.74, p < 0.001), SBP (before PSM: aHR = 1.87, 95% CI = 1.43–2.43, p < 0.001; after PSM: aHR = 1.76, 95% CI = 1.31–2.36, p = 0.002), HRS (before PSM: aHR = 1.48, 95% CI = 1.02–2.15, p = 0.04; after PSM: aHR = 1.47, 95% CI = 0.95–2.28, p = 0.09), and gastrointestinal bleeding (before PSM: aHR = 1.46, 95% CI = 1.12–1.90, p = 0.006; after PSM: aHR = 1.74, 95% CI = 1.28–2.37, p < 0.001). Conclusions The use of high‐dose PPI was independently associated with increased risks of mortality and cirrhotic complications.
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