肝硬化患者使用质子泵抑制剂和增加自发性细菌性腹膜炎风险:一项回顾性队列分析。

IF 1.4 Q4 GASTROENTEROLOGY & HEPATOLOGY
Gastroenterology Research Pub Date : 2022-08-01 Epub Date: 2022-08-23 DOI:10.14740/gr1545
Loai Dahabra, Malek Kreidieh, Mohammad Abureesh, Ahmad Abou Yassine, Liliane Deeb
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引用次数: 2

摘要

背景:质子泵抑制剂(PPIs)自20世纪80年代初问世以来,已在世界范围内广泛用于适应症。然而,不幸的是,PPIs被医疗保健提供者过度开处方,有时在缺乏明确适应症的情况下。虽然PPIs最初被认为具有良好的安全性,但新兴的研究已经阐明了长期使用PPIs与无数副作用之间的关系,包括自发性细菌性腹膜炎(SBP)风险增加的可能性。迄今为止,关于肝硬化患者使用PPI与收缩压发展之间的关系的数据是相互矛盾的。虽然一些观察性研究没有发现肝硬化患者使用PPI与SBP发生风险增加之间的关联,但许多其他研究支持这种关联。由于来自病例对照、队列和荟萃分析的结论相互矛盾,我们的目的是对基于电子病历的商业数据库EXPLORYS (IMB-WATSON, Cleveland, Ohio)中的肝硬化患者数据进行回顾性队列分析。我们的目的是评估肝硬化患者使用PPIs与SBP发展风险之间的可能关联,并比较积极使用PPIs的肝硬化患者与未使用PPIs的肝硬化患者之间SBP发展的患病率。方法:对纳入电子医疗记录商业数据库EXPLORYS (IMB-WATSON, Cleveland, Ohio)的肝硬化患者进行回顾性队列分析和图表复习。使用该数据库,审查了2017年12月至2020年期间的记录。纳入的患者年龄在30至79岁之间,经系统化医学临床术语命名法(SNOMED-CT)诊断为肝硬化。经SNOMED-CT诊断为肝硬化的患者被分为两组:第一组包括所有未使用PPIs的肝硬化患者,第二组包括所有在家使用PPIs的肝硬化患者。结果:在我们的分析中,无论是否积极服用PPIs,纳入的肝硬化患者中有1.7%(1860例患者)发生了SBP。在40670名在家接受PPIs治疗的肝硬化患者中,1350名(3.3%)患者发生了SBP。在多变量分析中,使用PPI是肝硬化患者SBP的最强预测因子(优势比(OR) = 4.24;95%可信区间(CI): 3.83 - 4.7, P值< 0.0001),服用PPIs的肝硬化患者发生SBP的可能性比未服用PPIs的患者高4.24。此外,PPI的使用、静脉曲张出血史、年龄、种族和性别被发现是独立的预测收缩压的因素,其重要性由高到低。结论:我们的回顾性队列分析显示,肝硬化患者使用PPIs是预测收缩压发生的独立危险因素。它巩固了接受这种治疗的肝硬化患者似乎有更高的发生收缩压的风险的论点。在新出现的证据表明PPIs可能对肝硬化患者造成健康风险的背景下,需要进一步的研究来解决目前这一主张的支持者和反对者之间的争论。此外,未来的研究可能有助于阐明肝硬化患者发生收缩压与使用PPIs的类型、剂量和持续时间之间的关系。我们建议除非有明确指示,否则肝硬化患者应避免或谨慎使用PPI治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Proton Pump Inhibitors Use and Increased Risk of Spontaneous Bacterial Peritonitis in Cirrhotic Patients: A Retrospective Cohort Analysis.

Background: Since their introduction in the early 1980s, proton pump inhibitors (PPIs) have been used worldwide for a broad range of indications. Unfortunately, however, PPIs have become overly prescribed by healthcare providers, sometimes in the absence of clear indications. Although PPIs were initially presumed to have an excellent safety profile, emerging studies have shed light on the association between their long-term use and a myriad of side effects, including the possibility of an increased risk of spontaneous bacterial peritonitis (SBP). Data available to date regarding the association between PPI use and SBP development in cirrhotic patients is conflicting. While some observational studies provide no association between PPI use in cirrhotic patients and an increased risk of SBP development, many others support this association. As a result of the conflicting conclusions from case controls, cohorts, and meta-analyses, we aimed to carry out this retrospective cohort analysis of data from cirrhotic patients included in the electronic medical record-based commercial database, EXPLORYS (IMB-WATSON, Cleveland, Ohio). Our aim was to evaluate for a possible association between PPIs use and the risk of SBP development in cirrhotic patients and to compare the prevalence of SBP development between cirrhotic patients who were actively using PPIs and those who were not.

Methods: A retrospective cohort analysis with chart review was conducted on patients with cirrhosis who were included in the electronic medical record-based commercial database, EXPLORYS (IMB-WATSON, Cleveland, Ohio). Using this database, records were reviewed between December 2017 and 2020. Included patients were adults aged 30 to 79 years with a Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) diagnosis of liver cirrhosis. Included patients with a SNOMED-CT diagnosis of liver cirrhosis were divided into two groups: the first group included all cirrhotic patients who did not use PPIs and the second group included all cirrhotic patients who were on PPIs at home.

Results: In our analysis, SBP occurred in 1.7% (1,860 patients) of the included cirrhotic patients whether they were actively taking PPIs or not. Among the 40,670 cirrhotic patients who were on PPIs at home, 1,350 (3.3%) patients developed SBP. On multivariate analysis, PPI use was the strongest predictor for SBP in cirrhotic patients (odds ratio (OR) = 4.24; 95% confidence interval (CI): 3.83 - 4.7, P value < 0.0001), with cirrhotic patients taking PPIs being 4.24 more likely to develop SBP than those not on PPIs. In addition, PPI use, history of bleeding varices, age, race, and gender were found to be independent predicting factors for SBP, in descending order of importance.

Conclusions: Our retrospective cohort analysis has shown that the use of PPIs in patients with liver cirrhosis is an independent predicting risk factor for SBP development. It solidified the argument that cirrhotic patients receiving this form of therapy seem to have a higher risk of developing SBP. In the setting of the emerging evidence that PPIs might impose health risks in cirrhotic patients, further studies are needed to settle the current debate between supporters and opponents of this proposition. In addition, future studies may help clarify the relationship between the occurrence of SBP in cirrhotic patients and the type, dose, and duration of PPIs used. We recommend that unless it is clearly indicated, PPI therapy should be avoided or administered with caution in patients with cirrhosis.

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Gastroenterology Research
Gastroenterology Research GASTROENTEROLOGY & HEPATOLOGY-
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