Effect of proton pump inhibitors in hospitalization on mortality of patients with hepatic encephalopathy and cirrhosis but no active gastrointestinal bleeding

Hung, Tsung–Hsing; Lee, Hsing–Feng; Tseng, Chih‐Wei; Tsai, Chen-Chi; Tsai, Chen–Chi

doi:10.1016/j.clinre.2017.11.011

Cited by 16 publications

(23 citation statements)

References 41 publications

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“…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…”

Section: Introductionmentioning

confidence: 89%

“…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]…”

Section: Study Characteristics and Quality Evaluationmentioning

confidence: 99%

“…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%.…”

Section: Study Characteristics and Quality Evaluationmentioning

confidence: 99%

“…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.…”

Section: Study Characteristics and Quality Evaluationmentioning

confidence: 99%

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

Wu¹,

Zhang

Yu³

et al. 2020

Bioscience Reports

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Background: Proton pump inhibitor (PPI) is commonly used in patients with cirrhosis. However, some studies demonstrated that PPI use was associated with adverse outcome in patients with cirrhosis. We aimed to perform a meta-analysis of cohort studies to evaluate the association between PPI use and mortality in cirrhotic patients. Methods: Relevant studies were obtained via search of PubMed and Embase databases. A randomized-effect model was used to pool the results. Subgroup analyses were performed to evaluate the source of heterogeneity. Results: Overall, 21 cohort studies with 20,899 patients and 7457 death events were included. The pooled results with a randomized-effect model showed that PPI use was associated with significantly increased risk of mortality in patients with cirrhosis (adjusted relative risk [RR] = RR: 1.39, P<0.001) with considerable heterogeneity (I2=73%). Subgroup analyses showed that characteristics such as patient ethnicity, sample size, definition of PPI use, and complications of patients did not affect the association. However, the association between PPI use and mortality was independent of study characteristics including patient ethnicity, sample size, complications, definition of PPI use, and follow-up duration. However, the association between PPI use and mortality in cirrhotic patients was significant in retrospective studies (RR: 1.40, P<0.001), but not in prospective studies (RR: 1.34, P=0.33). Conclusions: PPI use may be associated with moderately increased mortality in cirrhotic patients. Although prospective cohort studies are needed to validate our findings, PPI should only prescribed to cirrhotic patients with indications for the treatment.

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Section: Introductionmentioning

confidence: 89%

Section: Study Characteristics and Quality Evaluationmentioning

confidence: 99%

Section: Study Characteristics and Quality Evaluationmentioning

confidence: 99%

Section: Study Characteristics and Quality Evaluationmentioning

confidence: 99%

See 2 more Smart Citations

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

Wu¹,

Zhang

Yu³

et al. 2020

Bioscience Reports

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“…It is particularly concerning as PPIs are metabolised in the liver by cytochrome CYP450[11,14], and as a result, their half-life increases by 4-8 h in cirrhotic patients[15]. There have been concerns that PPI use increases the risk of mortality in patients with decompensated liver disease[16], and those with HE[17], but other studies dispute the association of mortality with PPI use in decompensated cirrhosis or cirrhotic patients with SBP[13,18]. Of the published data on PPI use and mortality in cirrhotic patients[13,16,17], “PPI users” are often defined as patients with PPI prescriptions at the study inclusion, and PPI dose duration is not measured.…”

Section: Introductionmentioning

confidence: 99%

Proton pump inhibitor use increases mortality and hepatic decompensation in liver cirrhosis

Roza¹,

Kai²,

Kam³

et al. 2019

WJG

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BACKGROUNDProton pump inhibitors (PPIs) are widely prescribed, often without clear indications. There are conflicting data on its association with mortality risk and hepatic decompensation in cirrhotic patients. Furthermore, PPI users and PPI exposure in some studies have been poorly defined with many confounding factors.AIMTo examine if PPI use increases mortality and hepatic decompensation and the impact of cumulative PPI dose exposure.METHODSData from patients with decompensated liver cirrhosis were extracted from a hospital database between 2013 to 2017. PPI users were defined as cumulative defined daily dose (cDDD) ≥ 28 within a landmark period, after hospitalisation for hepatic decompensation. Cox regression analysis for comparison was done after propensity score adjustment. Further risk of hepatic decompensation was analysed by Poisson regression.RESULTSAmong 295 decompensated cirrhosis patients, 238 were PPI users and 57 were non-users. PPI users had higher mortality compared to non-users [adjusted HR = 2.10, (1.20-3.67); P = 0.009]. Longer PPI use with cDDD > 90 was associated with higher mortality, compared to non-users [aHR = 2.27, (1.10-5.14); P = 0.038]. PPI users had a higher incidence of hospitalization for hepatic decompensation [aRR = 1.61, (1.30-2.11); P < 0.001].CONCLUSIONPPI use in decompensated cirrhosis is associated with increased risk of mortality and hepatic decompensation. Longer PPI exposure with cDDD > 90 increases the risk of mortality.

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General Management of Acute Variceal Bleeding

Escorsell

2022

Portal Hypertension VII

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Effect of proton pump inhibitors in hospitalization on mortality of patients with hepatic encephalopathy and cirrhosis but no active gastrointestinal bleeding

Cited by 16 publications

References 41 publications

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

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

Proton pump inhibitor use increases mortality and hepatic decompensation in liver cirrhosis

General Management of Acute Variceal Bleeding

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