PPIs use improves survival in cirrhosis patients with prior GI bleeding, study shows
USA: A recent study has found that the use of proton pump inhibitors (PPIs) for people with prior gastrointestinal bleeding (GIB) is associated with reduced mortality for veterans with cirrhosis. This indicates the benefit of PPIs in the presence of an appropriate indication.
"PPI exposure in other patients however was associated with an increased risk of decompensation and infection in cirrhosis, which may mediate liver-related mortality," Nadim Mahmud, Department of Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, and colleagues wrote in their study published in the journal Gastroenterology.
The impact of PPI medications on adverse outcomes in cirrhosis is controversial. Dr. Mahmud and the team, therefore, aimed to evaluate the association between PPI exposure and all-cause mortality, infection, and decompensation in a large national cohort.
For this purpose, the researchers conducted a retrospective study of patients with cirrhosis in the Veterans Health Administration. PPI exposure was distinguished as a time-updating variable from the index time of cirrhosis diagnosis. They performed inverse probability treatment weighting-adjusted Cox regression with additional adjustment for key time-varying covariates including cardiovascular comorbidities, gastrointestinal bleeding (GIB), and statin exposure.
The study showed the following findings:
· Of 76,251 included patients, 23,628 were on a PPI at baseline.
· In adjusted models, binary (yes/no) PPI exposure was associated with a reduced hazard of all-cause mortality in patients with hospitalization for GIB (HR 0.88) but had no significant association in all others (HR 0.99).
· Cumulative PPI exposure was associated with increased mortality in patients without hospitalization for GIB (HR 1.07 per 320mg-months [omeprazole-equivalents]).
· PPI exposure was significantly associated with severe infection (HR 1.21) and decompensation (HR 1.64).
· In a cause-specific mortality analysis, PPI exposure was associated with increased liver-related mortality (HR 1.23) but decreased non-liver-related mortality (HR 0.88).
"PPI exposure is associated with increased infection and decompensation risk in cirrhosis, which may mediate liver-related mortality," wrote the authors. "However, in those with prior GIB, PPI usage was associated with reduced all-cause mortality, suggesting benefit in the presence of an appropriate indication."
Reference:
The study titled, "The Association between Proton Pump Inhibitor Exposure and Key Liver-Related Outcomes in Patients with Cirrhosis: A Veterans Affairs Cohort Study," was published in the journal Gastroenterology.
