Mortality associated with proton pump inhibitors in cirrhotic patients with spontaneous bacterial peritonitis.
OBJECTIVE
The aims of this study were to investigate whether acid suppressive therapy increases the risk of spontaneous bacterial peritonitis (SBP) and to define factors associated with mortality in cirrhotic patients with SBP.


METHODS
Cirrhotic patients who had undergone paracentesis after hospitalization were included. Those patients were divided into two groups according to the presence or absence of SBP. Factors associated with the development of SBP were analyzed. Mortality rates during hospitalization or within 30 days after SBP and the factors associated with mortality were also analyzed.


RESULTS
A total of 1140 patients (median age, 62; men, 75%; model for end-stage liver disease [MELD] score, 17) were included. Five hundred thirty-three patients were identified as having SBP. In the logistic regression, the use of histamine-2 receptor antagonists, the use of proton pump inhibitors (PPIs), a high admission MELD score, and old age were associated with the development of SBP. The use of PPIs within 30 days (adjusted odds ratio [aOR] 1.960; 95% confidence interval [CI] 1.190-3.227; P = 0.008), a higher admission MELD score (aOR 1.054; 95% CI 1.032-1.076; P < 0.001), and hepatocellular carcinoma (aOR 1.852; 95% CI 1.256-2.730; P = 0.002) were associated with mortality after SBP.


CONCLUSIONS
Acid suppressive therapy is associated with the development of SBP in cirrhotic patients with ascites. The use of PPIs is associated with mortality after SBP independent of the severity of the underlying liver disease in our retrospective cohort study.
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Jee Hye
JH
Kwon
Seong-Joon
SJ
Koh
Won
W
Kim
Yong Jin
YJ
Jung
Ji Won
JW
Kim
Byeong Gwan
BG
Kim
Kook Lae
KL
Lee
Jong Pil
JP
Im
Yoon Jun
YJ
Kim
Joo Sung
JS
Kim
Jung-Hwan
JH
Yoon
Hyo-Suk
HS
Lee
Hyun Chae
HC
Jung
D000367:Age Factors; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality*; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000139:chemically induced* / Q000209:etiology / Q000382:microbiology / Q000401:mortality*; D054328:Proton Pump Inhibitors / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
D054328:Proton Pump Inhibitors
cirrhosis; histamine-2 receptor antagonists; mortality; peritonitis; proton pump inhibitors