Medizinische Klinik 1, Schwerpunkt Gastroenterologie und Hepatologie, Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt/Main, Germany.
Aliment Pharmacol Ther. 2015 Mar;41(5):459-66. doi: 10.1111/apt.13061. Epub 2014 Dec 19.
Proton pump inhibitors (PPI) are widely used in patients with liver diseases. Within the last years, there have been concerns about the PPI use as they may promote infections in patients with cirrhosis.
As there are sparse data of the prognostic relevance of PPI treatment, to perform a prospective study investigating the relation of PPI treatment and overall survival (OS) in cirrhotic individuals.
Patients with cirrhosis were enrolled and followed prospectively. The primary end point was OS. PPI treatment and additional clinical and laboratory data were assessed at the day of the study inclusion. The time until the end point death was assessed and the individual risks were calculated with Cox regression analyses.
A total of 272 patients were included and 213 individuals (78.3%) were on PPI treatment. In multivariate logistic regression analysis, PPI treatment was associated with higher MELD scores (P = 0.027) and ascites (P = 0.039). In a multivariate Cox regression model, PPI use was an independent predictor of mortality (hazard ratio 2.330, 95% confidence interval 1.264-4.296, P = 0.007) in addition to the model of end-stage liver disease (MELD) score, hepatocellular carcinoma and hepatic decompensation.
PPI use is an independent risk factor for mortality in patients with cirrhosis. Although a causative role for increased mortality in patients taking PPI is still missing, the prescription of PPI in cirrhotics should be considered carefully taking into account its potential adverse effects.
质子泵抑制剂（PPI）在肝病患者中广泛使用。近年来，由于担心 PPI 的使用可能会促进肝硬化患者的感染，因此引起了关注。
由于关于 PPI 治疗的预后相关性的数据很少，因此进行了一项前瞻性研究，以调查肝硬化患者中 PPI 治疗与总生存率（OS）之间的关系。
招募了肝硬化患者并进行了前瞻性随访。主要终点是 OS。在研究纳入当天评估 PPI 治疗和其他临床及实验室数据。评估直至终点死亡的时间，并使用 Cox 回归分析计算个体风险。
共纳入 272 例患者，其中 213 例（78.3%）接受 PPI 治疗。在多变量逻辑回归分析中，PPI 治疗与较高的 MELD 评分（P=0.027）和腹水（P=0.039）相关。在多变量 Cox 回归模型中，除终末期肝病模型（MELD）评分、肝细胞癌和肝功能失代偿外，PPI 使用还是死亡的独立预测因素（危险比 2.330，95%置信区间 1.264-4.296，P=0.007）。
PPI 的使用是肝硬化患者死亡的独立危险因素。尽管在服用 PPI 的患者中，增加死亡率的因果关系仍然缺失，但在考虑其潜在的不良反应时，应谨慎考虑在肝硬化患者中开具 PPI 处方。
