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

作　　者：Marianne Anastasia De Roza Lim Kai Jia Wen Kam Yiong Huak Chan Andrew Kwek Tiing Leong Ang John Chen Hsiang 

机构地区：[1]Department of Gastroenterology and Hepatology,Changi General Hospital,Singhealth 529889,Singapore [2]Clinical Trials and Research Unit,Changi General Hospital,Singhealth 529889,Singapore [3]Biostatistics Unit,Yong Loo Lin School of Medicine,National University of Singapore,Singapore 160608,Singapore

出　　处：《World Journal of Gastroenterology》2019年第33期4933-4944,共12页世界胃肠病学杂志（英文版）

摘　　要：BACKGROUND Proton 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.AIM To examine if PPI use increases mortality and hepatic decompensation and the impact of cumulative PPI dose exposure.METHODS Data 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.RESULTS Among 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].CONCLUSION PPI 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.BACKGROUND Proton 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.AIM To examine if PPI use increases mortality and hepatic decompensation and the impact of cumulative PPI dose exposure.METHODS Data 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(c DDD) ≥ 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.RESULTS Among 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 withhigher 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].CONCLUSION PPI 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.

关 键 词：Proton pump inhibitor Liver cirrhosis MORTALITY HOSPITALISATION Complications Portal hypertension Variceal bleeding ASCITES Spontaneous bacterial PERITONITIS Hepatic ENCEPHALOPATHY 

分 类 号：R[医药卫生]