Published online Sep 7, 2019. doi: 10.3748/wjg.v25.i33.4933
Peer-review started: March 25, 2019
First decision: May 24, 2019
Revised: July 12, 2019
Accepted: July 19, 2019
Article in press: July 19, 2019
Published online: September 7, 2019
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.
To examine if PPI use increases mortality and hepatic decompensation and the impact of cumulative PPI dose exposure.
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.
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].
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.
Core tip: Most proton pump inhibitor (PPI) studies have issues with poorly defining PPI users and having baseline confounders. Also, studies on PPI use in liver cirrhosis have not been focused on decompensated cirrhosis. Using propensity score analysis, we adjusted for 43 variables including baseline characteristics, comorbidities, PPI indication, and medications (including antiplatelets). Landmark analysis was used to define PPI users to reduce bias. PPI use in patients with decompensated liver cirrhosis was associated with higher mortality and increased risk of hepatic decompensation requiring hospital admissions. Longer PPI exposure with > 90 defined daily doses further increased mortality risk.