PPI use linked with risk for infection in decompensated cirrhosis

Sep 24 2012

By medwireNews Reporters

Proton-pump inhibitors (PPIs) are associated with an increased risk for serious infections in patients with decompensated cirrhosis, research shows.

Users of PPIs had a 66% higher risk for serious infection compared with nonusers, report investigators.

"This increase in risk occurs in a time-varying fashion and is not explained by confounding by concomitant drug use, comorbid conditions, or age," according to researcher Jasmohan Bajaj (Virginia Commonwealth University, Richmond, USA) and colleagues.

H2-receptor antagonists (H2RAs), on the other hand, did not appear to accelerate the rate of infection in decompensated cirrhosis.

Published in Alimentary Pharmacology and Therapeutics, the retrospective propensity-matched study included 1268 new users of PPIs matched with patients who did not initiate gastric acid suppression.

The majority of patients who were new users of PPIs were treated with omeprazole (73%) followed by rabeprazole (23%), lansoprazole (2%), or pantoprazole (1%).

Among individuals treated with PPIs, 25.3% developed serious infections, with acid suppression-related infections making up three out of every four infections.

Among a propensity-matched H2RA cohort, 25.9% developed serious infections, with 15% related to acid suppression.

Overall, the PPI users tended to develop serious acid suppression-related infections at a higher rate than nongastric acid suppressant users, although the difference was not statistically significant in a standard analysis.

In an analysis that accounted for the time-varying nature of PPI use, however, PPI users did develop serious infections at a higher rate than nonusers (hazard ratio=1.66).

"The initiation of PPI therapy accelerates the rate of infections associated with hospitalization, especially those related to intestinal bacterial overgrowth and translocation, in decompensated cirrhotic patients," write Bajaj and colleagues.

Infections are one of the leading causes of mortality in cirrhosis, "most of which have a presumed gut bacterial origin," they add.

In a similar analysis among users of H2RAs, the risk for serious infection was not statistically significant compared with nonusers.

Given that patients with decompensated cirrhosis remain at a high risk of serious infection, "clinicians should re-evaluate the reason for prescribing PPI and wherever possible, replace their acid suppressive needs with H2RAs," conclude the researchers.

Hepatitis C infection was common in new PPI users, affecting 52.4% of those treated with drugs, and in 46.0% of new users of H2RAs and 46.3% of nonusers.

Those treated with PPIs and H2RAs were also significantly more likely than nonusers to have at least five comorbid conditions (41.7% of PPI users, 41.9% of H2RA users, and 31.1% of nonusers).

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