Do Proton Pump Inhibitors Increase Mortality in Cirrhotic Patients with Spontaneous Bacterial Peritonitis?

Abstract

Introduction: Spontaneous bacterial peritonitis (SBP) is one of the most serious complications in cirrhotic patients. It has been reported that acid suppressants such as PPIs or H2RAs might cause small intestine bacterial overgrowth and bacterial translocation. However, little information is available whether acid suppression increases the risk of SBP and affects mortality rate in patients with advanced cirrhosis. Therefore, we designed a multi-center, cohort study that included a large number of cirrhotic patients to evaluate whether acid suppressive therapy increases the risk of SBP and to define the factors associated with mortality after SBP in cirrhotic patients with ascites.

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 (H2RAs), 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 to 3.227

P=0.008), a higher admission MELD score (aOR, 1.054

95% CI, 1.032 to 1.076

P<0.001), and hepatocellular carcinoma (aOR, 1.852

95% CI, 1.256 to 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.