期刊
GASTROENTEROLOGY
卷 163, 期 1, 页码 257-+出版社
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1053/j.gastro.2022.03.052
关键词
Proton Pump Inhibitor; Deprescribing; Gastrointestinal Bleed; Cirrhosis; Veterans Affairs
资金
- National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases [K08-DK124577, DK115897-03]
- VA Merit Grant [I01-CX002010]
- National Institutes of Health, National Cancer Institute [CA206465]
- VA Merit Grants [I01-CX-001933, I01-CX-002010]
The study found that PPI exposure in patients with cirrhosis is associated with increased risk of infection and decompensation, leading to higher liver-related mortality. However, in patients with prior gastrointestinal bleeding, PPI use is associated with reduced all-cause mortality, suggesting potential benefits.
BACKGROUND & AIMS: The impact of proton pump inhibitory (PPI) medications on adverse outcomes in cirrhosis remains controversial. We aimed to evaluate the association between PPI exposure and all-cause mortality, infection, and decompensation in a large national cohort. METHODS: This was a retrospective study of patients with cirrhosis in the Veterans Health Administration. PPI exposure was classified as a time-updating variable from the index time of the cirrhosis diagnosis. Inverse probability treatment weighting-adjusted Cox regression was performed with additional adjustment for key time-varying covariates, including cardiovascular comorbidities, gastrointestinal bleeding (GIB), and statin exposure. RESULTS: The study included 76,251 patients, 23,628 of whom were on a PPI at baseline. In adjusted models, binary (yes/no) PPI exposure was associated with reduced hazard of all-cause mortality in patients with hospitalization for GIB (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.84-0.91; P <.001) but had no significant association in all others (HR, 0.99; 95% CI, 0.97-1.02; P =.58). However, cumulative PPI exposure was associated with increased mortality in patients without hospitalization for GIB (HR, 1.07 per 320 mg-months [omeprazole equivalents]; 95% CI, 1.06-1.08; P <.001). PPI exposure was significantly associated with severe infection (HR, 1.21; 95% CI, 1.18-1.24; P <.001) and decompensation (HR, 1.64; 95% CI, 1.61-1.68; P <.001). In a cause-specific mortality analysis, PPI exposure was associated with increased liver-related mortality (HR, 1.23; 95% CI, 1.19-1.28) but with decreased nonliver-related mortality (HR, 0.88; 95% CI, 0.850.91). CONCLUSIONS: PPI exposure is associated with increased risk of infection and decompensation in cirrhosis, which may mediate liver-related mortality. However, PPI use was associated with reduced all-cause mortality in those with prior GIB, suggesting benefit in the presence of an appropriate indication.
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