High-dose proton pump inhibitor treatment is associated with a higher mortality in cirrhotic patients : A multicentre study
© 2024 John Wiley & Sons Ltd..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:59 |
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| Enthalten in: |
Alimentary pharmacology & therapeutics - 59(2024), 8 vom: 15. Apr., Seite 973-983 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Yoon, Jun Sik [VerfasserIn] |
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| Links: |
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| Themen: |
Bacterial translocation |
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| Anmerkungen: |
Date Completed 26.03.2024 Date Revised 09.04.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1111/apt.17909 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM368793079 |
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| 100 | 1 | |a Yoon, Jun Sik |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a High-dose proton pump inhibitor treatment is associated with a higher mortality in cirrhotic patients |b A multicentre study |
| 264 | 1 | |c 2024 | |
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| 500 | |a Date Completed 26.03.2024 | ||
| 500 | |a Date Revised 09.04.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2024 John Wiley & Sons Ltd. | ||
| 520 | |a BACKGROUND: Proton pump inhibitors (PPI) are frequently used in patients with cirrhosis | ||
| 520 | |a AIMS: This study aimed to determine whether PPI use is associated with the prognosis of cirrhotic patients | ||
| 520 | |a 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 | ||
| 520 | |a 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) | ||
| 520 | |a CONCLUSIONS: The use of high-dose PPI was independently associated with increased risks of mortality and cirrhotic complications | ||
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a bacterial translocation | |
| 650 | 4 | |a hepatic encephalopathy | |
| 650 | 4 | |a mean defined daily dose | |
| 650 | 4 | |a spontaneous bacterial peritonitis | |
| 650 | 7 | |a Proton Pump Inhibitors |2 NLM | |
| 700 | 1 | |a Hong, Ji Hoon |e verfasserin |4 aut | |
| 700 | 1 | |a Park, Soo Young |e verfasserin |4 aut | |
| 700 | 1 | |a Kim, Seung Up |e verfasserin |4 aut | |
| 700 | 1 | |a Kim, Hwi Young |e verfasserin |4 aut | |
| 700 | 1 | |a Kim, Ju Yeon |e verfasserin |4 aut | |
| 700 | 1 | |a Hur, Moon Haeng |e verfasserin |4 aut | |
| 700 | 1 | |a Park, Min Kyung |e verfasserin |4 aut | |
| 700 | 1 | |a Lee, Yun Bin |e verfasserin |4 aut | |
| 700 | 1 | |a Lee, Han Ah |e verfasserin |4 aut | |
| 700 | 1 | |a Kim, Gi-Ae |e verfasserin |4 aut | |
| 700 | 1 | |a Sinn, Dong Hyun |e verfasserin |4 aut | |
| 700 | 1 | |a Park, Sung Jae |e verfasserin |4 aut | |
| 700 | 1 | |a Lee, Youn Jae |e verfasserin |4 aut | |
| 700 | 1 | |a Kim, Yoon Jun |e verfasserin |4 aut | |
| 700 | 1 | |a Yoon, Jung-Hwan |e verfasserin |4 aut | |
| 700 | 1 | |a Lee, Jeong-Hoon |e verfasserin |4 aut | |
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