Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 18, 2017; 9(35): 1278-1285
Published online Dec 18, 2017. doi: 10.4254/wjh.v9.i35.1278
Influence of proton pump inhibitors in the development of spontaneous bacterial peritonitis
Suelen A S Miozzo, Jorge A John, Marcelo C Appel-da-Silva, Isabella A Dossin, Cristiane V Tovo, Angelo A Mattos
Suelen A S Miozzo, Jorge A John, Marcelo C Appel-da-Silva, Isabella A Dossin, Cristiane V Tovo, Angelo A Mattos, Graduate Program in Medicine, Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre CEP 90430-080, Brazil
Author contributions: Mattos AA conceptualized and designed this study; Miozzo SAS, John JA, Appel-da-Silva MC and Dossin IA collected the data; Miozzo SAS reviewed the literature and wrote the manuscript with substantial contribution of Mattos AA; Mattos AA and Tovo CV reviewed the manuscript critically for important intellectual content; all authors approved the final version of the manuscript.
Institutional review board statement: The study protocol was approved by the institutional review board for human studies at the UFCSPA.
Conflict-of-interest statement: The authors state no conflicts of interest. No financial support was provided for the study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Cristiane V Tovo, MD, PhD, Adjunct Professor, Assistant Professor, Graduate Program in Medicine, Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Cel Aurelio Bitencourt 115/201, Porto Alegre CEP 90430-080, Brazil. cristianev@ufcspa.edu.br
Telephone: +55-51-32148158
Received: July 7, 2017
Peer-review started: July 17, 2017
First decision: August 7, 2017
Revised: August 25, 2017
Accepted: November 3, 2017
Article in press: November 3, 2017
Published online: December 18, 2017
Abstract
AIM

To investigate whether the use of proton pump inhibitors (PPIs) increases the incidence of spontaneous bacterial peritonitis (SBP) in patients with cirrhosis and ascites.

METHODS

An historical cohort study was carried out in cirrhotic outpatients with ascites followed in a specialized clinic at a tertiary hospital in Southern Brazil. Patient charts were reviewed to collect information on the variables of interest as the use of PPIs. Primary outcome was defined as development of SBP during the study period. SBP was diagnosed based on ascitic fluid polymorphonuclear cell count ≥ 250 cells/mm³ without evidence of an intra-abdominal, surgically treatable source of infection.

RESULTS

Of 738 cirrhotic patients, 582 (58.2% male) were enrolled, with mean age of 53.6 ± 12 years. Hepatitis C virus infection (36.2%) and alcohol abuse (25.6%) were the main etiologies of cirrhosis. The presence of ascites was detected in 299 (51.4%) patients during the development of the study. Nineteen patients with previous diagnosis of SBP undergoing secondary prophylaxis and 22 patients with insufficient PPI data were further excluded. Of 258 patients with ascites, 151 used PPIs, and 34 developed SBP (22.5%). Among 107 non-users of PPIs, 23 developed SBP (21.5%) (HR = 1.44, 95%CI: 0.85-2.47, P = 0.176). The median follow-up time of patients using PPI was 27 mo vs 32 mo for non-users. Univariate analysis of the risk factors associated with the development of SBP revealed a significant association of SPB with the severity of liver disease according to the Child-Turcotte-Pugh (CTP) score. Multivariate analysis confirmed that CTP score was the only independent variable influencing the occurrence of SBP. Survival at 60 mo (Kaplan-Meier analysis) was similar in users and non-users of PPI, independently of the presence of SBP (58.4% vs 62.7% respectively, P = 0.66). For patients with SBP, survival at 60 mo was 55.1%, vs 61.7% in patients without SBP (P = 0.34).

CONCLUSION

In conclusion, the rate of SBP was not significantly different in users or non-users of PPIs in this cohort of cirrhotic with ascites.

Keywords: Cirrhosis, Bacterial infection, Spontaneous bacterial peritonitis, Proton pump inhibitors, Ascites

Core tip: The aim of the present study was to investigate whether the use of proton pump inhibitors (PPIs) increases the incidence of spontaneous bacterial peritonitis (SBP) in patients with cirrhosis and ascites. An historical cohort study was carried out with cirrhotic patients. The primary outcome was development of SBP. Of 258 patients with ascites, 151 used PPIs, and 34 developed SBP (22.5%). Among 107 non-users of PPIs, 23 developed SBP (21.5%) (HR = 1.44, 95%CI: 0.85-2.47, P = 0.176). In conclusion, the use of PPIs does not increase the incidence of SBP in patients with cirrhosis and ascites.