Use of proton pump inhibitors is associated with a higher risk of pneumonia in cirrhotic patients: a systematic review and meta-analysis

Wongtrakul, Wasit; Charoenngnam, Nipith; Ungprasert, Patompong

doi:10.20524/aog.2020.0483

Cited by 7 publications

(11 citation statements)

References 25 publications

(32 reference statements)

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“…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

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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.

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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

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“…Some studies indicate that patients with liver cirrhosis are prone to bacterial infections 24,25 because of their impaired immune status, the increased use of invasive procedures, and alterations in the enteric flora. 26,27 For example, Hermos et al 10 showed that use of PPI would increase the risk of CAP by 1.80-fold when compared with non-PPI use in liver disease patients. The pooled analysis of Wongtrakul et al 27 found that cirrhotic patients with a history of PPI use had a significantly higher risk of developing pneumonia than those without PPI use, with a pooled risk ratio of 1.36 (95% CI = 1.00-1.85; I 2 = 47%).…”

Section: Interpretation Within the Context Of The Wider Literaturementioning

confidence: 99%

“…26,27 For example, Hermos et al 10 showed that use of PPI would increase the risk of CAP by 1.80-fold when compared with non-PPI use in liver disease patients. The pooled analysis of Wongtrakul et al 27 found that cirrhotic patients with a history of PPI use had a significantly higher risk of developing pneumonia than those without PPI use, with a pooled risk ratio of 1.36 (95% CI = 1.00-1.85; I 2 = 47%). However, in our meta-analysis, use of PPI was not associated with CAP in liver disease populations.…”

Section: Interpretation Within the Context Of The Wider Literaturementioning

confidence: 99%

Proton Pump Inhibitors and the Risk of Community-Acquired Pneumonia: An Updated Meta-analysis

Xun

Yin

et al. 2021

Ann Pharmacother

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Background: Some studies suggested an increased risk of community-acquired pneumonia (CAP) among proton pump inhibitors (PPI) users. However, the published evidence is inadequate to define the association between PPI use and the risk of CAP. Objective: The aims of our meta-analysis were to systematically assess the association between the risk of CAP and PPI use in adults to reduce the adverse effects of PPI and ensure the safety of medication for patients. Methods: A comprehensive literature search was conducted, published between January 1, 2004, and February 1, 2021. The primary outcome was the incidence of CAP. This meta-analysis was performed using odds ratios (ORs) with 95% CIs as effective measures; 13 studies including 2 098 804 patients were enrolled in our meta-analysis. Results: Our study revealed that the incidence of CAP was higher in PPI users than non -PPI users [OR = 1.37 (95% CI = 1.22–1.53)], especially for PPI duration < 30 days [OR = 1.49 (95% CI = 1.34–1.66)]. Compared with non-PPI use, PPI use increased the incidence of CAP in the stroke disease population [OR = 1.52 (95% CI = 1.33–1.75)], but not in the liver disease population [OR = 1.13 (95% CI = 0.98–1.30)]. Conclusions and Relevance: Using PPI could increase the risk of CAP when compared to not using PPI. PPI use increased the incidence of CAP in patients with stroke. Clinicians and clinical pharmacists should weigh the benefits before medication and strictly control the indication of the prescription, so as to reduce adverse reactions.

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“…New articles on contemporary topics such as PPI safety are regularly added to the global medical literature, which may make it difficult to sum- With this letter, we would like to expand on the work of Salvo et al by mentioning six more recent meta-analyses that were published after their search date. [3][4][5][6][7][8] (Table 1) Several additional adverse effects of PPIs have been evaluated such as increased risk of hepatocellular carcinoma, pancreatic cancer, congenital malformations, and complications in patients with cirrhosis including spontaneous bacterial peritonitis, pneumonia and hepatic encephalopathy.…”

Section: Letter: Mind the Gap -Search And Publication Date Of Systematic Reviews And Meta-analysismentioning

confidence: 99%

Letter: mind the gap – search and publication date of systematic reviews and meta‐analysis

Patel

Spychalski

Kobiela

2021

Aliment Pharmacol Ther

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Use of proton pump inhibitors is associated with a higher risk of pneumonia in cirrhotic patients: a systematic review and meta-analysis

Cited by 7 publications

References 25 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

Proton Pump Inhibitors and the Risk of Community-Acquired Pneumonia: An Updated Meta-analysis

Letter: mind the gap – search and publication date of systematic reviews and meta‐analysis

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