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

Wu, Xiaoli; Zhang, Daofu; Yu, Yuexiao; Lou, Lianqing; Li, Xiaofei

doi:10.1042/bsr20193890

Cited by 10 publications

(6 citation statements)

References 47 publications

(113 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In total, we identified 6241 articles, scrutinised 375 full‐text articles, and included 132 eligible articles (3.52%) for preliminary data extraction ( Figure S1). After the selection criteria for the overlapping meta‐analyses were applied, 61 articles were ultimately selected for evidence synthesis 6–8,31–88 . Agreement between reviewers for eligibility of articles was excellent (κ statistic = 0.8).…”

Section: Resultsmentioning

confidence: 99%

Association of proton‐pump inhibitor use with adverse health outcomes: A systematic umbrella review of meta‐analyses of cohort studies and randomised controlled trials

Veettil

Sadoyu²,

Bald

et al. 2021

Brit J Clinical Pharma

View full text Add to dashboard Cite

The aim was to perform an umbrella review to summarise the existing evidence on proton-pump inhibitor (PPI) use and adverse outcomes and to grade the certainty of evidence.Methods: Electronic databases were searched up to July 2021 for meta-analyses of cohort studies and/or randomised controlled trials (RCTs). Summary effect sizes from a random-effects model, between-study heterogeneity, 95% prediction interval, small-study effect, excess significance and credibility ceilings were devised to classify the credibility of evidence from meta-analyses of cohort studies, whereas the GRADE approach was used for meta-analyses of RCTs.Results: In meta-analyses of cohort studies, 52 of the 91 examined associations were statistically significant (P ≤ .05). Convincing evidence emerged from main analysis for the association between PPI use and risk of all-site fracture and chronic kidney disease in the elderly population. However, none of these associations remained supported by convincing evidence after sensitivity analyses. The use of PPI is also associated with an increased risk of mortality due to COVID-19 infection and other related adverse outcomes, but the quality of evidence was weak. In meta-analyses of RCTs, 38 of the 63 examined associations were statistically significant. However, no associations were supported by high or moderate-quality evidence.Conclusion: This study's findings imply that most putative adverse outcomes associated with PPI use may not be supported by high-quality evidence and are likely to have been affected by underlying confounding factors. Future research is needed to confirm the causal association between PPI use and risk of fracture and chronic kidney disease.

show abstract

Section: Resultsmentioning

confidence: 99%

Association of proton‐pump inhibitor use with adverse health outcomes: A systematic umbrella review of meta‐analyses of cohort studies and randomised controlled trials

Veettil

Sadoyu²,

Bald

et al. 2021

Brit J Clinical Pharma

View full text Add to dashboard Cite

show abstract

“…Accordingly, prophylactic medications for GIB, such as proton pump inhibitors (PPIs), are often prescribed in these patients, particularly when aspirin is indicated. However, the use of PPIs in cirrhotic patients has been related to increased risks of adverse events such as hepatic encephalopathy, spontaneous bacterial peritonitis, and possibly HCC and mortality ( 39 , 40 ). Therefore, the influence of aspirin use in cirrhotic patients with HBV or HCV infection may be much more complicated in real-world clinical practice, which warrants delicately designed RCTs to evaluate the potential benefits on HCC and risks of GIB.…”

Section: Discussionmentioning

confidence: 99%

Aspirin Use and the Incidence of Hepatocellular Carcinoma in Patients With Hepatitis B Virus or Hepatitis C Virus Infection: A Meta-Analysis of Cohort Studies

Li¹,

Wu²,

Yu³

2021

Front. Med.

Self Cite

View full text Add to dashboard Cite

Background: The association between aspirin use and the incidence of hepatocellular carcinoma (HCC) in patients with hepatitis B virus (HBV) or hepatitis C (HCV) virus infection remains not fully determined. A meta-analysis was performed to summarize the findings of cohort studies.Methods: Relevant cohort studies were retrieved via a search of PubMed Cochrane's Library and Embase databases. A random-effect model was used to pool the results. Subgroup analyses were performed to evaluate the influence of study characteristics on the association.Results: Seven cohort studies with 120,945 adult patients with HBV or HCV infection were included. Pooled results showed that aspirin use was independently associated with a reduced risk of HCC in these patients (risk ratio: 0.73, 95% confidence interval: 0.64 to 0.83, p < 0.001; I2 = 86%). Subgroup analyses showed that aspirin use was associated with a reduced HCC risk regardless of the viral type, age, sex, the diabetic, and cirrhotic status of the patients, and the follow-up durations. Moreover, consistent results were obtained in studies with and without adjustment of antiviral treatment and statin use. Pooled results of four studies showed that aspirin use was associated with an increased risk of gastrointestinal bleeding in these patients (risk ratio: 1.15, 95% confidence interval: 1.02 to 1.28, p = 0.02; I2 = 0%).Conclusions: Aspirin use was independently associated with a reduced risk of HCC in patients with HBV or HCV infection, whereas the risk of gastrointestinal bleeding may be increased. These results should be validated in clinical trials.

show abstract

“…PPI influence on CDI development has been well documented. Several meta-analyses concluded that their use may foster CDI appearance, thus promoting them as an independent risk factor [ 26 , 27 , 28 , 29 ]. Several theories were suggested, mainly based on the PPI’s effect with acid suppression [ 30 ] and gene expression decrease, which maintain the colonocyte integrity [ 31 ] or by decreasing microbial diversity [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Clostridioides difficile Infection among Cirrhotic Patients with Variceal Bleeding

et al. 2021

View full text Add to dashboard Cite

Clostridioides difficile infection (CDI) stands as the leading cause of nosocomial infection with high morbidity and mortality rates, causing a major burden on the healthcare system. Driven by antibiotics, it usually affects older patients with chronic disease or immunosuppressed or oncologic management. Variceal bleeding secondary to cirrhosis requires antibiotics to prevent bacterial translocation, and thus patients become susceptible to CDI. We aimed to investigate the risk factors for CDI in cirrhotic patients with variceal bleeding following ceftriaxone and the mortality risk in this patient’s population. We retrospectively screened 367 cirrhotic patients with variceal bleeding, from which 25 patients were confirmed with CDI, from 1 January 2017 to 31 December 2019. We found MELD to be the only multivariate predictor for mortality (odds ratio, OR = 1.281, 95% confidence interval, CI: 0.098–1.643, p = 0.042). A model of four predictors (age, days of admission, Charlson index, Child–Pugh score) was generated (area under the receiver operating characteristics curve, AUC = 0.840, 95% CI: 0.758–0.921, p < 0.0001) to assess the risk of CDI exposure. Determining the probability of getting CDI for cirrhotic patients with variceal bleeding could be a tool for doctors in taking decisions, which could be integrated in sustainable public health programs.

show abstract

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

Cited by 10 publications

References 47 publications

Association of proton‐pump inhibitor use with adverse health outcomes: A systematic umbrella review of meta‐analyses of cohort studies and randomised controlled trials

Association of proton‐pump inhibitor use with adverse health outcomes: A systematic umbrella review of meta‐analyses of cohort studies and randomised controlled trials

Aspirin Use and the Incidence of Hepatocellular Carcinoma in Patients With Hepatitis B Virus or Hepatitis C Virus Infection: A Meta-Analysis of Cohort Studies

Clostridioides difficile Infection among Cirrhotic Patients with Variceal Bleeding

Contact Info

Product

Resources

About