Long-term PPI Use Reduces Bleeding-Related Mortality in Cirrhosis Patients
BOSTON, MA—Long-term use of proton pump inhibitors (PPIs) reduced bleeding-related mortality in patients with cirrhosis and variceal bleeding, a prospective study reported at The Liver Meeting® 2016.
“Furthermore, PPIs did not increase incidence of infection,” noted Sang Hoon Kwon, MD, Department of Gastroenterology and Hepatology, Kyungpook National University Hospital, Daegu, the Republic of Korea.
Although PPIs are “widely used in patients with cirrhosis,” there has been some debate as to their effectiveness, Dr. Kwon and colleagues noted.
To investigate the effect of long-term PPI therapy on overall survival and incidence of infection in patients with cirrhosis and variceal bleeding, from 2007 to 2013 the investigators prospectively enrolled 348 consecutive patients with gastroesophageal variceal bleeding, 175 (50.3%) of whom were on long-term PPI therapy and 173 (49.7%) who were not. Patient follow-up was conducted in 3-month intervals.
The primary endpoint was overall survival.
“Cox's regression model was used to determine factors associated with survival and infection,” they reported.
There were 185 deaths, 80 (45.7%) in PPI group and 105 (60.7%) in the non-PPI group. Survival curves for both groups showed a significant difference (P=0.002).
By multivariate analysis, independent predictors of survival were MELD score (HR 1.1; 95% CI: 1.1, 1.2; P<0.001), Child-Pugh score (HR 1.3; 95% CI: 1.2, 1.4; P<0.001), infection (HR 1.7; 95% CI: 1.1, 2.6; P=0.019), hepatocellular carcinoma (HR 2.9; 95% CI: 2.1, 4.0; P<0.001), varix size (HR 1.0; 95% CI: 1.011, 1.038; P=0.041), and PPI therapy (HR 0.5; 95% CI: 0.4, 0.7; P<0.001).
Among patients whose cause of death was identified, bleeding was most common in both the PPI (38.1%) and non-PPI (47.5%) groups.
According to a subgroup analysis by bleeding death (n=44), factors that predicted death were similar to that for all-cause mortality, including PPI therapy. Infection was not associated with bleeding death (P=0.267), and there was no significant difference in incidence of infection between the PPI (n=18; 10.3%) and non-PPI (n=14; 8.1%) groups (P=0.479).
Severity of underlying liver disease was found to be most predictive of infection. Multivariate analysis showed that Child-Pugh score (HR 1.3; 95% CI: 1.1, 1.6; P=0.003) was an independent predictor of infection; however, PPI therapy was not (P=0.342).