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Proton pump inhibitors are associated with a high rate of serious infections in veterans with decompensated cirrhosis
Author(s) -
Bajaj J. S.,
Ratliff S. M.,
Heuman D. M.,
Lapane K. L.
Publication year - 2012
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.12045
Subject(s) - medicine , cirrhosis , decompensation , hazard ratio , pneumonia , proton pump inhibitor , gastroenterology , bacteremia , confidence interval , antibiotics , microbiology and biotechnology , biology
Summary Background There is increasing evidence that proton pump inhibitors ( PPI s) increase the rate of infections in patients with decompensated cirrhosis. Aims To estimate the extent to which proton pump inhibitors ( PPI s) increase the rate of infections among patients with decompensated cirrhosis. Methods We conducted a retrospective propensity‐matched new user design using US Veterans Health Administration data. Only decompensated cirrhotic patients from 2001 to 2009 were included. New PPI users after decompensation ( n = 1268) were 1:1 matched to those who did not initiate gastric acid suppression. Serious infections, defined as infections associated with a hospitalisation, were the outcomes. These were separated into acid suppression‐related ( SBP , bacteremia, C lostridium difficile and pneumonia) and non‐acid suppression‐related. Time‐varying Cox models were used to estimate adjusted hazard ratios ( HR ) and 95% CI s of serious infections. Parallel analyses were conducted with H2 receptor antagonists ( H 2 RA ). Results More than half of persons with decompensated cirrhosis were new users of gastric acid suppressants, with most using PPI s (45.6%) compared with H 2 RA s (5.9%). In the PPI propensity‐matched analysis, 25.3% developed serious infections and 25.9% developed serious infections in the H 2 RA analysis. PPI users developed serious infections faster than nongastric acid suppression users (adjusted HR : 1.66; 95% CI : 1.31–2.12). For acid suppression‐related serious infections, PPI users developed the outcome at a rate 1.75 times faster than non‐users (95% CI : 1.32–2.34). The H 2 RA findings were not statistically significant ( HR serious infections: 1.59; 95% CI : 0.80–3.18; HR acid suppression‐related infections: 0.92; 95% CI : 0.31–2.73). Conclusion Among patients with decompensated cirrhosis, proton pump inhibitors but not H2 receptor antagonists increase the rate of serious infections.