Proton pump inhibitor use is associated with a variety of infections in patients with liver cirrhosis.
Proton pump inhibitor use is associated with a variety of infections in patients with liver cirrhosis.
复制标题
DOI：
10.1097/md.0000000000023436
复制
发表时间：
2020-12-11
期刊：
影响因子：
1.6
通讯作者：
Adarkwah CC
中科院分区：
文献类型：
--
作者：
Labenz C;Kostev K;Galle PR;Wörns MA;Labenz J;Tanislav C;Adarkwah CC
有证据表明，摄入质子泵抑制剂（PPI）会增加肝硬化患者发生自发性细菌性腹膜炎（SBP）的风险。然而，关于PPI摄入量对收缩压以外感染发生的影响的数据仍然缺乏。我们假设，在肝硬化患者中，PPI的使用与除收缩压外的较高感染率相关。目前的病例对照研究样本包括来自疾病分析数据库（IQVIA）的肝硬化患者，该数据库汇编了从德国全科医生和专家那里获得的风险因素、药物处方和诊断等数据。共有2823名感染患者与2823名未感染患者通过倾向评分进行匹配。为了量化PPI的使用，分析了指数日期前12个月的PPI处方量。感染患者使用PPI的频率明显高于无感染患者（47.9% vs 37.9%）。在回归分析中，PPI的使用与总体感染发生率显著相关（OR 1.55, 95% CI 1.39-1.72, P < 0.05）。001)，并与下呼吸道感染、尿路感染和感染性胃肠炎的发生有关。使用PPI与皮肤感染之间没有关联。泮托拉唑和奥美拉唑是最常用的ppi，两者都与感染的发生独立相关。肝硬化患者使用PPI可能与收缩压以外的感染有关。PPI的处方应限于有明确适应症的患者。
There is evidence that intake of proton pump inhibitors (PPI) increases the risk for spontaneous bacterial peritonitis (SBP) in patients with liver cirrhosis. However, data regarding the impact of PPI intake on occurrence of infections other than SBP are still lacking. We hypothesized that PPI use is associated with a higher rate of infections other than SBP in patients with liver cirrhosis. The current case-control study sample included patients with liver cirrhosis from the Disease Analyzer database (IQVIA), which compiles data such as risk factors, drug prescriptions and diagnoses obtained from general practitioners and specialists in Germany. In total, 2,823 patients with infections were matched with 2,823 patients without infections by propensity scores. For quantification of PPI use the prescribed quantity of PPI during the past 12 months before index date was analyzed. Frequency of PPI users was significantly higher in patients with infections than in patients without infections (47.9% vs 37.9%). In regression analysis, PPI use was significantly associated with the occurrence of infections overall (OR 1.55, 95% CI 1.39–1.72, P < .001), and associated with the occurrence of lower respiratory tract infections, urinary tract infections and infectious gastroenteritis. There was no association between PPI use and skin infections. Pantoprazole and omeprazole were the most frequently prescribed PPIs and were both independently associated with the occurrence of infections. PPI use may be associated with infections other than SBP in patients with liver cirrhosis. Prescription of PPI should be limited to patients with a clear indication.