Effect of proton pump inhibitors on the risk and prognosis of infections in patients with cirrhosis and ascites

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BACKGROUND & AIMS: Many patients with cirrhosis use proton pump inhibitors (PPI). We aimed to determine their effects on the risk and prognosis of infections in patients with cirrhosis and ascites.

METHODS: We used data from three 1-year trials of satavaptan treatment of ascites (N=1198) to compare incidence and 90-day mortality of first-time infections between users and nonusers of PPI. With standard and marginal structural Cox models we adjusted for differences in gender, age, cirrhosis etiology, MELD score, serum albumin, lactulose use, severity of ascites, and history of spontaneous bacterial peritonitis or variceal bleeding.

RESULTS: During the follow-up 446 patients had an infection. At inclusion, 524 patients (44%) used PPI, and 645 (54%) used them at some point during the follow-up. PPI use increased the rate of infections overall (adjusted hazard ratio = 1.43, 95% CI 1.18-1.74), and it also increased the rate of all specific types of infections except upper respiratory tract infections of presumably viral origin. The estimated cumulative risk of infections was 36.4% for PPI users vs. 25.1% for nonusers at 6 months (relative risk = 1.45, 95% CI 1.22-1.73), and 45.2% vs. 37.7% at 1 year (relative risk = 1.20, 95% 0.97-1.40). Use of PPI did not affect mortality during the 90 days following infection (adjusted hazard ratio = 0.83, 95% CI 0.53-1.31).

CONCLUSIONS: Approximately half of patients with cirrhosis and ascites use PPI. This use increases their risk of bacterial infections, but does not affect their prognosis after an infection occurs. This article is protected by copyright. All rights reserved.

Original languageEnglish
JournalLiver International
Pages (from-to)514-521
Number of pages8
Publication statusPublished - Mar 2019

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