Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark.
Liver Int. 2019 Mar;39(3):514-521. doi: 10.1111/liv.14012. Epub 2018 Dec 18.
BACKGROUND & AIMS: Many patients with cirrhosis use proton pump inhibitors. We aimed to determine their effects on the risk and prognosis of infections in patients with cirrhosis and ascites.
We used data from three 1-year trials of satavaptan treatment of ascites (N = 1198) to compare incidence and 90-day mortality of first-time infections between users and nonusers of proton pump inhibitors. With standard and marginal structural Cox models, we adjusted for differences in gender, age, cirrhosis aetiology, Model for End-stage Liver Disease score, serum albumin, lactulose use, severity of ascites, and history of spontaneous bacterial peritonitis or variceal bleeding.
During the follow-up, 446 patients had an infection. At inclusion, 524 patients (44%) used proton pump inhibitors, and 645 (54%) used them at some point during the follow-up. Proton pump inhibitor use increased the rate of infections overall (adjusted hazard ratio = 1.43, 95% CI 1.18-1.74), and it also increased the rate of all specific types of infections except upper respiratory tract infections of presumably viral origin. The estimated cumulative risk of infections was 36.4% for proton pump inhibitor users vs 25.1% for nonusers at 6 months (relative risk = 1.45, 95% CI 1.22-1.73), and 45.2% vs 37.7% at 1 year (relative risk = 1.20, 95% 0.97-1.40). Use of proton pump inhibitors did not affect mortality during the 90 days following infection (adjusted hazard ratio = 0.83, 95% CI 0.53-1.31).
Approximately half of patients with cirrhosis and ascites use proton pump inhibitors. This use increases their risk of bacterial infections, but does not affect their prognosis after an infection occurs.
许多肝硬化患者使用质子泵抑制剂。我们旨在确定质子泵抑制剂对肝硬化伴腹水患者感染风险和预后的影响。
我们使用了三种为期 1 年的 Satavaptan 治疗腹水的临床试验的数据（n=1198），比较了质子泵抑制剂使用者和非使用者首次感染的发生率和 90 天死亡率。使用标准和边缘结构 Cox 模型，我们调整了性别、年龄、肝硬化病因、终末期肝病模型评分、血清白蛋白、乳果糖使用、腹水严重程度以及自发性细菌性腹膜炎或静脉曲张出血史的差异。
在随访期间，有 446 例患者发生感染。纳入时，524 例患者（44%）使用质子泵抑制剂，645 例患者（54%）在随访期间的某个时间点使用质子泵抑制剂。质子泵抑制剂的使用增加了总体感染率（调整后的危险比=1.43，95%CI 1.18-1.74），并且增加了除可能由病毒引起的上呼吸道感染以外的所有特定类型感染的发生率。质子泵抑制剂使用者的累积感染风险在 6 个月时为 36.4%，而非使用者为 25.1%（相对风险=1.45，95%CI 1.22-1.73），在 1 年时为 45.2%和 37.7%（相对风险=1.20，95%CI 0.97-1.40）。质子泵抑制剂的使用并不影响感染后 90 天内的死亡率（调整后的危险比=0.83，95%CI 0.53-1.31）。
大约一半的肝硬化伴腹水患者使用质子泵抑制剂。这种使用增加了他们发生细菌感染的风险，但不影响感染发生后的预后。
