The Association Between Proton Pump Inhibitor Exposure and Key Liver-Related Outcomes in Patients With Cirrhosis: A...

Area of Science:

• Gastroenterology
• Hepatology
• Pharmacology

Background:

• The impact of proton pump inhibitors (PPIs) on adverse outcomes in cirrhosis patients is debated.
• This study investigates the association between PPI use and mortality, infection, and decompensation in a large cirrhosis cohort.

Purpose of the Study:

• To evaluate the association between proton pump inhibitor (PPI) exposure and adverse outcomes, including all-cause mortality, infection, and decompensation, in patients with cirrhosis.
• To determine if PPI use offers benefits or risks in specific subgroups of cirrhosis patients, such as those with a history of gastrointestinal bleeding (GIB).

Main Methods:

• Retrospective analysis of a large national cohort (76,251 patients) diagnosed with cirrhosis within the Veterans Health Administration.
• Time-updating variable classification for PPI exposure from cirrhosis diagnosis.
• Inverse probability treatment weighting-adjusted Cox regression with adjustments for comorbidities, GIB, and statin use.

Main Results:

• Overall PPI exposure was linked to increased severe infection (HR, 1.21) and decompensation (HR, 1.64).
• PPI use showed reduced all-cause mortality in patients hospitalized for GIB (HR, 0.88) but not in others (HR, 0.99).
• Cumulative PPI exposure increased mortality in patients without prior GIB hospitalization (HR, 1.07), and was associated with higher liver-related mortality (HR, 1.23) but lower non-liver-related mortality (HR, 0.88).

Conclusions:

• Proton pump inhibitor (PPI) use is associated with a higher risk of infection and decompensation in cirrhosis patients, potentially contributing to liver-related mortality.
• PPIs may reduce all-cause mortality in cirrhosis patients with a history of gastrointestinal bleeding, suggesting a benefit when there is a clear indication for use.