High-dose PPI use among cirrhotic patients poses risk of death, complications

Patients with cirrhosis who are exposed to high-dose proton pump inhibitors (PPIs) are at increased risk of death and cirrhotic complications, as suggested in a retrospective study.

Researchers reviewed the medical records of 1,485 patients (median age 61 years, 61 percent men) who had hepatic encephalopathy (HE) across seven referral centres in Korea. Patients treated with PPI at a mean defined daily dose (mDDD) of ≥0.5 comprised the high-dose PPI group, whereas those treated with PPI of an mDDD of <0.5 comprised the control group.

Overall survival was the primary outcome. Secondary outcomes included the development of cirrhotic complications, including recurrent HE, spontaneous bacterial peritonitis (SBP), hepatorenal syndrome (HRS), and gastrointestinal bleeding.

Of the patients, 232 were in the high-dose PPI group and 1,253 were in the control group. Compared with nonuse or low-dose PPI use, high-dose PPI use was independently associated with an excess risk of death (adjusted hazard ratio [aHR], 1.71, 95 percent confidence interval [CI], 1.38–2.11; p<0.001). This result was replicated in a propensity score-matching analysis (PSM; aHR, 1.90, 95 percent CI, 1.49–2.44; p<0.001).

Furthermore, high-dose PPI use was positively associated with the following adverse outcomes: recurrent HE (before PSM: aHR, 2.04, 95 percent CI, 1.66–2.51, p<0.001; after PSM: aHR, 2.16, 95 percent CI, 1.70–2.74, p<0.001), SBP (before PSM: aHR, 1.87, 95 percent CI, 1.43–2.43, p<0.001; after PSM: aHR, 1.76, 95 percent CI, 1.31–2.36, p=0.002), HRS (before PSM: aHR, 1.48, 95 percent CI, 1.02–2.15, p=0.04; after PSM: aHR, 1.47, 95 percent CI, 0.95–2.28, p=0.09), and gastrointestinal bleeding (before PSM: aHR, 1.46, 95 percent CI, 1.12–1.90, p=0.006; after PSM: aHR, 1.74, 95 percent CI, 1.28–2.37, p<0.001).