Proton pump inhibitors do not impact on the severity and mortality of acute-on-chronic liver failure - Andalusian...

proton pump inhibitors (PPI) are widely consumed worldwide, but there is a lack of prospective studies that evaluate their impact on acute-on-chronic liver failure (ACLF). The main objective of this study was to assess if chronic PPI therapy increases ACLF severity and mortality. Secondary endpoints were ACLF severity using Chronic Liver Failure - Consortium Organ Failure (CLIF-C-OF) on admission and Chronic Liver Failure - Consortium ACLF (CLIF-C-ACLF) score on admission, day 3 and 7; 28-day, three-month and six-month mortality; the relationship with the different forms of ACLF acute decompensation; PPI dosage and hospital stay.

a prospective cohort study was conducted recruiting all patients diagnosed with ACLF and categorizing them as exposed or not exposed, based on chronic PPI use. Upon admission, chronic PPI use and their usual treatment were documented. The CLIF-C-OF score and the CLIF-C-ACLF score were assessed on admission, in addition to Child-Pugh score, Model for End-Stage Liver Disease-Sodium score and the type of decompensation. Liver, kidney and hematological function parameters and new hospitalizations for ACLF and mortality rates at 28 days, three- and six-months post-admission were collected.

fifty-nine patients were enrolled (median age of 59 years): 26 were chronic PPI users and 33 non-users. Among PPI users, 69 % did not have a documented indication for PPI use. The most frequent type of decompensation was hepatic encephalopathy, followed by hydropic decompensation and infections (66.7 %, 56.7 % and 48.3 % respectively). No significant relationship was observed between chronic PPI use and the severity of the ACLF (CLIF-C-OFs p = 0.44, CLIF-C-ACLFs p = 0.87). Similarly, there was no significant association found between chronic PPI use and the different types of decompensation within ACLF nor with mortality during admission (p = 0.63), at 28 days (p = 0.70) and three months (p = 0.98).

chronic PPI use was not independently associated with ACLF severity or mortality and a high prevalence of inappropriate prescriptions was identified.