Effect of proton pump inhibitors on mortality of cirrhotic patients with pneumonia

Abstract

Objective Pneumonia is life-threatening in patients with liver cirrhosis. Proton pump inhibitors (PPIs) may increase the risk of these patients developing pneumonia. However, whether PPIs increase mortality in patients with cirrhosis and pneumonia remain unknown. Methods We used the Taiwan National Health Insurance Database to enroll 1,201 cirrhotic patients with pneumonia without active gastrointestinal bleeding who were receiving PPIs and were hospitalized between January 1, 2010 and December 31, 2013. A one-to-three propensity score match was performed to select a comparison group based on age, gender, and comorbid disorders. Results The overall 30-day and 90-day all-cause mortality rates were 13.7% and 26.9% in the PPI group, and 14.3% and 25.1% in the non-PPI group, respectively. After Cox regression model adjusting for age, gender, and comorbid disorders, the hazard ratios of the effect of PPIs on 30-day and 30 to 90-day mortality were 0.94 (95% Confidence Interval [CI], 0.79–1.12, P = 0.468) and 1.26 (95% CI, 1.05–1.52; P = 0.013), respectively. Conclusions PPIs were not associated with 30-day mortality among cirrhotic patients with pneumonia but not active gastrointestinal bleeding. However, prolonged PPI therapy may be associated with higher mortality.

The Phylogeny and Biological Function of Gastric Juice—Microbiological Consequences of Removing Gastric Acid

“…The study was not designed explicitly to examine the risk of pneumonia. In a mortality study of cirrhotic patients with pneumonia, but not active gastrointestinal bleeding, PPIs were not associated with 30 day mortality [179]. However, the authors stated that prolonged PPI therapy may be associated with higher mortality.…”

Proton pump inhibitor use and mortality in patients with cirrhosis: a meta-analysis of cohort studies

“…An early meta-analysis published in 2015 showed that PPI use was not associated with increased mortality in patients with cirrhosis [11]. However, only four cohort studies [14,16,17,19] were included in the present study, and many related cohort studies have been published since the previous meta-analysis [18,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. In addition, it remains unknown…”

“…Overall, 21 cohort studies with 20,899 patients and 7457 death events were included, of which 16 were retrospective cohort studies [16][17][18][19][22][23][24][25][26][27][28][29][30][31][32][33], while the other five were prospective cohort [14,15,20,21,34]. As for the ethnicity of the patients, 12 studies included Caucasian patients [15,16,18,[20][21][22]24,28,29,[32][33][34], 7 included Asians [17,19,23,25,26,30,31], and the remaining 2 included patients with mixed ethnicity [14,27]. Most of the studies included patients with hospitalized patients with cirrhosis without serious clinical complications [14][15][16][17][18]…”

“…As for the ethnicity of the patients, 12 studies included Caucasian patients [15,16,18,[20][21][22]24,28,29,[32][33][34], 7 included Asians [17,19,23,25,26,30,31], and the remaining 2 included patients with mixed ethnicity [14,27]. Most of the studies included patients with hospitalized patients with cirrhosis without serious clinical complications [14][15][16][17][18][20][21][22][23][24][28][29][30]32,34], while six studies included cirrhotic patients with SBP [19,26], HE [25], Clostridium difficile infection [27], pneumonia [31], and after transjugular intrahepatic portosystemic shunt [33], respectively. The mean ages of the patients varied from 53 to 63 years, and the proportions of male patients varied from 53% to 77%.…”

“…The mean ages of the patients varied from 53 to 63 years, and the proportions of male patients varied from 53% to 77%. PPI use was defined as concurrent use at the admission in 13 studies [14,[16][17][18]20,22,[25][26][27][28][29]31,34], and any use during follow up in eight studies [15,19,21,23,24,30,32,33]. The follow-up durations varied from within hospitalization to 60 months.…”