Severe clinical outcomes of COVID-19 associated with proton pump inhibitors: a nationwide cohort study with propensity score matching
Severe clinical outcomes of COVID-19 associated with proton pump inhibitors: a nationwide cohort study with propensity score matching
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DOI：
10.1136/gutjnl-2020-322248
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发表时间：
2021-01-01
期刊：
影响因子：
24.5
通讯作者：
Yon, Dong Keon
中科院分区：
文献类型：
--
作者：
Lee, Seung Won;Ha, Eun Kyo;Yon, Dong Keon
目的质子泵抑制剂（PPIs）治疗肺炎的不良反应已有报道，但对于PPIs是否对严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）感染的风险有害，目前尚无共识。在这方面，我们的目的是衡量目前使用PPI与接受SARS-CoV-2检测的患者中COVID-19感染率的潜在关联。设计数据来自韩国全国性队列研究，采用倾向评分匹配。我们纳入了132316名18岁以上的患者，他们在2020年1月1日至5月15日期间进行了SARS-CoV-2检测。终点为SARS-CoV-2阳性（主要）和COVID-19的严重临床结局（次要：入住重症监护病房、实施有创通气或死亡）。结果在整个队列中，有111 911名未使用PPI的患者，14 163名目前使用PPI的患者和6242名既往使用PPI的患者。在倾向评分匹配后，SARS-CoV-2检测阳性率与当前或过去使用PPI无关。在确诊的COVID-19患者中，目前使用PPI使COVID-19严重临床结局的风险增加79%，而与既往使用PPI的关系仍然不显著。在过去30天内开始使用PPI的患者发生COVID-19严重临床结局的风险增加90%。结论使用PPI的患者发生COVID-19严重临床结局的风险增加，但对SARS-CoV-2感染不敏感。这表明，医生需要在COVID-19大流行期间评估酸相关疾病管理的获益-风险评估。
Objective The adverse effects of proton pump inhibitors (PPIs) have been documented for pneumonia; however, there is no consensus regarding whether the use of PPIs might be harmful regarding the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In this regard, we aimed to measure the potential associations of the current use of PPIs with the infection rates of COVID-19 among patients who underwent SARS-CoV-2 testing.Design Data were derived from a Korean nationwide cohort study with propensity score matching. We included 132 316 patients older than 18 years who tested for SARS-CoV-2 between 1 January and 15 May 2020. Endpoints were SARS-CoV-2 positivity (primary) and severe clinical outcomes of COVID-19 (secondary: admission to intensive care unit, administration of invasive ventilation or death).Results In the entire cohort, there were 111 911 non-users, 14 163 current PPI users and 6242 past PPI users. After propensity score matching, the SARS-CoV-2 test positivity rate was not associated with the current or past use of PPIs. Among patients with confirmed COVID-19, the current use of PPIs conferred a 79% greater risk of severe clinical outcomes of COVID-19, while the relationship with the past use of PPIs remained insignificant. Current PPI use starting within the previous 30 days was associated with a 90% increased risk of severe clinical outcomes of COVID-19.Conclusion Patients taking PPIs are at increased risk for severe clinical outcomes of COVID-19 but not susceptible to SARS-CoV-2 infection. This suggests that physicians need to assess benefit-risk assessments in the management of acid-related diseases amid the COVID-19 pandemic.