The Association Between Proton Pump Inhibitor Exposure and Key Liver-Related Outcomes in Patients With Cirrhosis: A Veterans Affairs Cohort Study.
The Association Between Proton Pump Inhibitor Exposure and Key Liver-Related Outcomes in Patients With Cirrhosis: A Veterans Affairs Cohort Study.
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DOI：
10.1053/j.gastro.2022.03.052
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发表时间：
2022-07
期刊：
影响因子：
29.4
通讯作者：
中科院分区：
文献类型：
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作者：
质子泵抑制（PPI）药物对肝硬化不良后果的影响仍然存在争议。我们的目的是在大型全国队列中评估 PPI 暴露与全因死亡率、感染和失代偿之间的关联。这是一项针对退伍军人健康管理局肝硬化患者的回顾性研究。 PPI 暴露被归类为肝硬化诊断索引时间的时间更新变量。进行逆概率治疗权重调整的 Cox 回归，并对关键时变协变量进行额外调整，包括心血管合并症、胃肠道出血 (GIB) 和他汀类药物暴露。在纳入的 76,251 名患者中，有 23,628 名患者在基线时接受了 PPI。在调整后的模型中，二元（是/否）PPI 暴露与 GIB 住院患者全因死亡率风险降低相关（HR 0.88，95% CI 0.84–0.91，p<0.001），但与所有其他患者没有显着相关性（HR 0.99，95% CI 0.97–1.02，p=0.58）。然而，累积 PPI 暴露与患者死亡率增加相关无需因 GIB 住院（HR 1.07 每 320 毫克/月[奥美拉唑当量]，95% CI 1.06-1.08，p<0.001）。PPI 暴露与严重感染（HR 1.21，95% CI 1.18-1.24，p<0.001）和失代偿（HR 1.64，95% CI）显着相关。 1.61–1.68，p<0.001）。在特定原因死亡率分析中，PPI 暴露与肝脏相关死亡率增加相关（HR 1.23，95% CI 1.19–1.28），但非肝脏相关死亡率降低（HR 0.88，95% CI 0.85–0.91）。然而，PPI 的使用与既往 GIB 患者的全因死亡率降低相关，这表明在存在适当适应症的情况下是有益的。
The impact of proton pump inhibitory (PPI) medications on adverse outcomes in cirrhosis remains controversial. We aimed to evaluate the association between PPI exposure and all-cause mortality, infection, and decompensation in a large national cohort. This was a retrospective study of patients with cirrhosis in the Veterans Health Administration. PPI exposure was classified as a time-updating variable from the index time of cirrhosis diagnosis. Inverse probability treatment weighting-adjusted Cox regression was performed with additional adjustment for key time-varying covariates including cardiovascular comorbidities, gastrointestinal bleeding (GIB), and statin exposure. Of 76,251 included patients, 23,628 were on a PPI at baseline. In adjusted models, binary (yes/no) PPI exposure was associated with reduced hazard of all-cause mortality in patients with hospitalization for GIB (HR 0.88, 95% CI 0.84–0.91, p<0.001) but had no significant association in all others (HR 0.99, 95% CI 0.97–1.02, p=0.58. However, cumulative PPI exposure was associated with increased mortality in patients without hospitalization for GIB (HR 1.07 per 320mg-months [omeprazole-equivalents], 95% CI 1.06–1.08, p<0.001). PPI exposure was significantly associated with severe infection (HR 1.21, 95% CI 1.18–1.24, p<0.001) and decompensation (HR 1.64, 95% CI 1.61–1.68, p<0.001). In a cause-specific mortality analysis, PPI exposure was associated with increased liver-related mortality (HR 1.23, 95% CI 1.19–1.28), but decreased non-liver-related mortality (HR 0.88, 95% CI 0.85–0.91). PPI exposure is associated with increased risk of infection and decompensation in cirrhosis, which may mediate liver-related mortality. However, PPI usage was associated with reduced all-cause mortality in those with prior GIB, suggesting benefit in the presence of an appropriate indication.
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DOI：
10.1002/hep.31558
发表时间：
2021-01
期刊：
Hepatology (Baltimore, Md.)
影响因子：
--
作者：
Mahmud N;Fricker Z;Hubbard RA;Ioannou GN;Lewis JD;Taddei TH;Rothstein KD;Serper M;Goldberg DS;Kaplan DE
通讯作者：
Kaplan DE
影响因子：
1.6
作者：
Labenz C;Kostev K;Galle PR;Wörns MA;Labenz J;Tanislav C;Adarkwah CC
通讯作者：
Adarkwah CC
影响因子：
4.1
作者：
Kwon, Jee Hye;Koh, Seong-Joon;Jung, Hyun Chae
通讯作者：
Jung, Hyun Chae
影响因子：
9.8
作者：
Bauer, TM;Steinbrückner, B;Blum, HE
通讯作者：
Blum, HE
影响因子：
13.5
作者：
Chang, CS;Chen, GH;Yeh, HZ
通讯作者：
Yeh, HZ