Sun Shanshan, Ye Wenyi, Zhao Ruihong, Hu Jianhua, Zhang Xuan, Yang Meifang, Zhao Hong, Sheng Jifang
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Traditional Chinese Internal Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
Front Med (Lausanne). 2021 Nov 10;8:763370. doi: 10.3389/fmed.2021.763370. eCollection 2021.
The aim of this study was to investigate the impact of proton pump inhibitor (PPI) therapy on complications and prognosis in cirrhosis patients with and without acute-on-chronic liver failure (ACLF). Cirrhosis patients with acute decompensation (AD) ( = 489) admitted in our center were enrolled in this prospective observational cohort study. According to treatment received, patients were identified as users or nonusers of PPI. Clinical and laboratory data, complications during hospitalization, and overall survival were recorded in all the patients. Of the 489 patients, 299 (61.1%) patients received PPI therapy. The logistic regression analysis showed that age, albumin, history of previous hepatic encephalopathy (HE), and the chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score were independent risk factors for HE in patients with decompensated cirrhosis [odds ratio (OR) = 1.07, 95% CI: 1.03-1.12, = 0.001; OR = 1.13, 95% CI: 1.04-1.24, = 0.006; OR = 242.52, 95% CI: 40.17-1464.11, < 0.001; and OR = 2.89, 95% CI: 2.11-3.96, < 0.001, respectively]. Previous severe liver injury and previous bacterial infections were independent risk factors for spontaneous bacterial peritonitis (SBP) in patients with decompensated cirrhosis (OR = 3.43, 95% CI: 1.16-10.17, = 0.026 and OR = 6.47, 95% CI: 2.29-18.29, < 0.001, respectively). The multivariate Cox proportional hazards regression model showed that the type and dose of the PPI used were not related to 28-day and 90-day mortality in cirrhosis patients with AD or ACLF. PPI use does not appear to increase mortality or the risk of HE and SBP in the hospitalized cirrhosis patients with and without ACLF.
本研究旨在调查质子泵抑制剂（PPI）治疗对伴有和不伴有慢加急性肝衰竭（ACLF）的肝硬化患者并发症及预后的影响。本前瞻性观察队列研究纳入了我院收治的489例急性失代偿期（AD）肝硬化患者。根据接受的治疗，将患者分为PPI使用者和非使用者。记录所有患者的临床和实验室数据、住院期间的并发症及总生存期。489例患者中，299例（61.1%）接受了PPI治疗。逻辑回归分析显示，年龄、白蛋白、既往肝性脑病（HE）病史以及慢性肝衰竭序贯器官衰竭评估（CLIF-SOFA）评分是失代偿期肝硬化患者发生HE的独立危险因素[比值比（OR）=1.07，95%置信区间（CI）：1.03 - 1.12，P = 0.001；OR = 1.13，95%CI：1.04 - 1.24，P = 0.006；OR = 242.52，95%CI：40.17 - 1464.11，P < 0.001；OR = 2.89，95%CI：2.11 - 3.96，P < 0.001]。既往严重肝损伤和既往细菌感染是失代偿期肝硬化患者发生自发性细菌性腹膜炎（SBP）的独立危险因素（OR分别为3.43，95%CI：1.16 - 10.17，P = 0.026；OR = 6.47，95%CI：2.29 - 18.29，P < 0.001）。多因素Cox比例风险回归模型显示，使用的PPI类型和剂量与AD或ACLF肝硬化患者的28天及90天死亡率无关。在伴有或不伴有ACLF的住院肝硬化患者中，使用PPI似乎不会增加死亡率或发生HE和SBP的风险。
