PPI exposure worsens clinical outcomes , increases mortality in COVID-19 patients
A recent study published in the European Journal of Gastroenterology and Hepatology suggests prehospitalization Proton Pump Inhibitor (PPI) exposure is independently associated with worse clinical outcomes, including mortality in COVID-19 patients.
Common proton pump inhibitors used for gastritis or gastric ulcer include pantoprazole,Omeprazole, Lansoprazole, Rabeprazole and esomeprazole.
Emerging evidence suggests that COVID-19 can also present with gastrointestinal (GI) symptoms, including nausea, vomiting, dysgeusia, diarrhea, and abdominal pain. The angiotensin-converting enzyme 2 (ACE2) has been identified as the receptor for SARS CoV-2, which is highly expressed throughout the GI system. Gastric acid suppression by PPI including pantoprazole, Omeprazole, Lansoprazole, Rabeprazole, esomeprazole might allow SARS-CoV-2 entry into the enterocytes and replication, leading to increased GI symptoms causing colitis and enteritis which could predispose the patients to severe COVID-19. However, the precise relationship between proton pump inhibitors (PPIs) exposure and COVID-19 is unclear. For this purpose, the researchers studied the association between pre-hospitalization PPI exposure and clinical outcomes among hospitalized COVID-19 patients.
It was a retrospective cohort study on 295 patients with COVID-19 in a tertiary care academic medical centre in Brooklyn, New York, from March 1 to April 25, 2020. They were divided into two groups based on PPI-exposure before admission: COVID-19 patients on PPI (PPI-group) and not on PPI (no-PPI-group) among which 15.6% of hospitalized COVID-19 patients were on PPIs at home. Researchers determined all-cause mortality and ARDS (Acute Respiratory Distress Syndrome) as a primary outcome. They also performed a subgroup analysis to examine the heterogeneity of PPI effects on mortality outcomes.
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