Effect of proton pump inhibitors on mortality of cirrhotic patients with pneumonia

• Published in: PloS one Vol. 14; no. 4; p. e0216041
• Main Authors: Hung, Tsung-Hsing, Tseng, Chih -Wei, Tsai, Chih-Chun, Lee, Hsing-Feng
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 25.04.2019; Public Library of Science (PLoS)
• Subjects: Acids; Administration, Oral; Antibiotics; Bacterial infections; Bleeding; Buddhism; Care and treatment; Cirrhosis; Clinical medicine; Comorbidity; Complications and side effects; Confidence intervals; Datasets; Development and progression; Disease; Disorders; Drug dosages; Esophagus; Female; Gastrointestinal hemorrhage; Gastrointestinal Hemorrhage - chemically induced; Health insurance; Hospital patients; Hospitalization; Hospitals; Humans; Infections; Inhibitors; Insurance; Liver; Liver cirrhosis; Liver Cirrhosis - complications; Liver Cirrhosis - drug therapy; Liver Cirrhosis - mortality; Male; Medical records; Medicine; Middle Aged; Mortality; National health insurance; Pantoprazole; Patient outcomes; Pneumonia; Pneumonia - complications; Proportional Hazards Models; Proton pump inhibitors; Proton Pump Inhibitors - administration & dosage; Proton Pump Inhibitors - therapeutic use; Regression models; Risk Factors; Statistical analysis; Survival Analysis; Systematic review; Ulcers; Taiwan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0216041

Pneumonia is life-threatening in patients with liver cirrhosis. Proton pump inhibitors (PPIs) may increase the risk of these patients developing pneumonia. However, whether PPIs increase mortality in patients with cirrhosis and pneumonia remain unknown. We used the Taiwan National Health Insurance Database to enroll 1,201 cirrhotic patients with pneumonia without active gastrointestinal bleeding who were receiving PPIs and were hospitalized between January 1, 2010 and December 31, 2013. A one-to-three propensity score match was performed to select a comparison group based on age, gender, and comorbid disorders. The overall 30-day and 90-day all-cause mortality rates were 13.7% and 26.9% in the PPI group, and 14.3% and 25.1% in the non-PPI group, respectively. After Cox regression model adjusting for age, gender, and comorbid disorders, the hazard ratios of the effect of PPIs on 30-day and 30 to 90-day mortality were 0.94 (95% Confidence Interval [CI], 0.79-1.12, P = 0.468) and 1.26 (95% CI, 1.05-1.52; P = 0.013), respectively. PPIs were not associated with 30-day mortality among cirrhotic patients with pneumonia but not active gastrointestinal bleeding. However, prolonged PPI therapy may be associated with higher mortality.