Do Proton Pump Inhibitors Increase Mortality in Cirrhotic Patients with Spontaneous Bacterial Peritonitis?
J Gastroenterol Hepatol. 2013 Nov 13;
Authors: Kwon JH, Koh SJ, Kim W, Jung YJ, Kim JW, Kim BG, Lee KL, Im JP, Kim YJ, Kim JS, Yoon JH, Lee HS, Jung HC
BACKGROUND AND AIM: The aims of this study was to investigate whether acid suppressive therapy increases the risk of spontaneous bacterial peritonitis (SBP) and to define factors associated with mortality in cirrhotic patients with SBP.
METHODS: Cirrhotic patients who had undergone paracentesis after hospitalization were included. Those patients were divided into two groups according to the presence or absence of SBP. Factors associated with the development of SBP were analyzed. Mortality rates during hospitalization or within 30 days after SBP and the factors associated with mortality were also analyzed.
RESULTS: A total of 1140 patients [Median age, 62; Men, 75%; model for end-stage liver disease (MELD) score, 17] were included. Five hundred thirty three patients were identified as having SBP. In the logistic regression, the use of histamine-2 receptor antagonists (H2RAs), the use of proton pump inhibitors (PPIs), a high admission MELD score, and old age were associated with the development of SBP. The use of PPIs within 30 days (adjusted odds ratio [aOR], 1.960; 95% confidence interval [CI], 1.190 to 3.227; P=0.008), a higher admission MELD score (aOR, 1.054; 95% CI, 1.032 to 1.076; P<0.001), and hepatocellular carcinoma (aOR, 1.852; 95% CI, 1.256 to 2.730; P=0.002) were associated with mortality after SBP.
CONCLUSIONS: Acid suppressive therapy is associated with the development of SBP in cirrhotic patients with ascites. The use of PPIs is associated with mortality after SBP independent of the severity of the underlying liver disease in our retrospective cohort study.
PMID: 24219827 [PubMed - as supplied by publisher]