title: Proton pump inhibitor use significantly increases the risk of spontaneous bacterial peritonitis in 1965 patients with cirrhosis and ascites: a propensity score matched cohort study.
abstract: BACKGROUND
  The risk of spontaneous bacterial peritonitis (SBP) associated with proton pump inhibitor (PPI) use has been raised in cirrhotic patients with ascites. However, this is based on case-control studies, often with a small series.
  
  
  OBJECTIVE
  To determine whether PPI use increases the risk of SBP using a large cohort.
  
  
  METHODS
  This retrospective cohort study included 1965 cirrhotic patients with ascites diagnosed between January 2005 and December 2009. The SBP incidence rate was compared between the PPI and non-PPI groups before and after propensity score matching to reduce the effect of selection bias and potential confounders. Multivariate analysis was conducted to confirm the association of PPI use with SBP.
  
  
  RESULTS
  After excluding 411 patients, 1554 were analysed. Among them, 512 patients (32.9%) were included in the PPI group. The annual SBP incidence rate was higher in the PPI group than in the non-PPI group (10.6% and 5.8%, P = 0.002) before matching. Indications for PPI use and dose of PPI were similar between patients with and without SBP. In the propensity score matched cohort (402 pairs), the SBP incidence rate was also higher in the PPI group than in the non-PPI group (10.8% vs. 6.0%, P = 0.038). Multivariate analysis revealed that PPI use (Hazard ratio 1.396; 95% confidence interval, 1.057-1.843; P = 0.019) was the independent risk factor for SBP.
  
  
  CONCLUSIONS
  Proton pump inhibitor use significantly increases the risk of spontaneous bacterial peritonitis in cirrhotic patients with ascites. Proton pump inhibitor use should be undertaken with greater caution and appropriately in patients with cirrhosis.
authors: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors: Y W
authors: YW
authors: Min
authors: K S
authors: KS
authors: Lim
authors: B-H
authors: BH
authors: Min
authors: G-Y
authors: GY
authors: Gwak
authors: Y H
authors: YH
authors: Paik
authors: M S
authors: MS
authors: Choi
authors: J H
authors: JH
authors: Lee
authors: J J
authors: JJ
authors: Kim
authors: K C
authors: KC
authors: Koh
authors: S W
authors: SW
authors: Paik
authors: B C
authors: BC
authors: Yoo
authors: P-L
authors: PL
authors: Rhee
mesh_terms: D000368:Aged; D001201:Ascites / Q000150:complications* / Q000453:epidemiology; D001424:Bacterial Infections / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000150:complications* / Q000453:epidemiology; D057216:Propensity Score; D054328:Proton Pump Inhibitors / Q000009:adverse effects*; D012189:Retrospective Studies
chemical_list: D054328:Proton Pump Inhibitors