Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
Centre for Information Management (ZIMt), Hannover Medical School, Hannover, Germany.
Liver Int. 2018 Sep;38(9):1602-1613. doi: 10.1111/liv.13862. Epub 2018 May 7.
BACKGROUND & AIMS: Spontaneous bacterial peritonitis is a severe complication in patients with cirrhosis leading to acute kidney injury, hepatic encephalopathy and a high mortality. In this study, we aimed to investigate the impact of proton pump inhibitors and the potential relevance of the taken dosage on the incidence and clinical course of spontaneous bacterial peritonitis.
Overall, 613 consecutive patients with decompensated cirrhosis were included. All patients were carefully evaluated for proton pump inhibitors intake including the applied dosage and were further followed up for spontaneous bacterial peritonitis development as well as for the incidence of clinical complications like hepatic encephalopathy, acute kidney injury and mortality.
Cumulative spontaneous bacterial peritonitis incidence did neither differ between the proton pump inhibitors and the no-proton pump inhibitors group nor between those taking the high (>40 mg/d) and the low (10-40 mg/d) proton pump inhibitors' dose. However, proton pump inhibitors' intake was associated with an impaired clinical course of spontaneous bacterial peritonitis reflected by a higher likelihood for acute kidney injury (71% vs 43%; P = .002), severe hepatic encephalopathy (15% vs 0%; P = .04) and an increased mortality (24% vs 0%; P = .008) within 28 days after spontaneous bacterial peritonitis diagnosis. In particular, patients with proton pump inhibitors dosages >40 mg/d had an increased short-term risk for acute kidney injury (adjusted hazard ratio: 1.86; P = .009) and mortality (adjusted hazard ratio: 2.05; P = .02). In contrast, there was no effect of proton pump inhibitors on acute kidney injury, hepatic encephalopathy and mortality in patients without spontaneous bacterial peritonitis irrespective of the applied proton pump inhibitors dosage.
High dosages of proton pump inhibitors are associated with an adverse outcome in patients with spontaneous bacterial peritonitis. Thus, indication for high-dosage proton pump inhibitors therapy should be evaluated carefully in these patients.
自发性细菌性腹膜炎是肝硬化患者的一种严重并发症，可导致急性肾损伤、肝性脑病和高死亡率。本研究旨在探讨质子泵抑制剂的应用及其剂量与自发性细菌性腹膜炎的发生率和临床病程的关系。
共纳入 613 例失代偿期肝硬化患者。所有患者均接受质子泵抑制剂（PPIs）摄入情况评估，包括应用剂量，并进一步随访自发性细菌性腹膜炎的发生情况以及肝性脑病、急性肾损伤和死亡率等临床并发症的发生率。
PPIs 组与非 PPI 组、高剂量 (>40mg/d) 与低剂量 (10-40mg/d) PPI 组的累积自发性细菌性腹膜炎发生率无差异。然而，质子泵抑制剂的应用与自发性细菌性腹膜炎的临床病程恶化有关，表现为急性肾损伤的发生风险更高（71% vs 43%；P=.002）、严重肝性脑病（15% vs 0%；P=.04）和死亡率增加（24% vs 0%；P=.008）。在自发性细菌性腹膜炎诊断后 28 天内尤其如此。特别是，PPI 剂量 >40mg/d 的患者发生急性肾损伤（调整后的危险比：1.86；P=.009）和死亡（调整后的危险比：2.05；P=.02）的短期风险增加。相反，无论应用质子泵抑制剂的剂量如何，无自发性细菌性腹膜炎的患者中，质子泵抑制剂对急性肾损伤、肝性脑病和死亡率均无影响。
高剂量质子泵抑制剂与自发性细菌性腹膜炎患者的不良结局相关。因此，应慎重评估这些患者高剂量质子泵抑制剂治疗的适应证。
