Proton pump inhibitors in cirrhosis: a retrospective five-year analysis of increased risks of hepatic decompensation and infections.

AIM: Proton pump inhibitors (PPIs) are widely used in cirrhotic patients, often without a clear indication. Evidence links PPI use to adverse outcomes such as hepatic encephalopathy and spontaneous bacterial peritonitis. This study analyses outcomes associated with PPI use in cirrhosis over 5 years at a New Zealand tertiary centre.

METHODS

This retrospective study included all patients diagnosed with liver cirrhosis at Counties Manukau Health in 2014. Patients were divided into two groups: those taking PPIs and those not taking PPIs. Demographic data, relevant blood tests and cumulative PPI doses were recorded. Outcomes such as mortality, liver-related events (hepatic encephalopathy, spontaneous bacterial peritonitis, variceal bleeding and ascites) and infections were monitored over 5 years. Logistic regression analyses calculated odds ratios (ORs) for the association of PPI usage with outcomes, adjusting for age, comorbidities, medications, aetiology of cirrhosis and liver disease severity.

RESULTS

Of 392 patients, 304 (77%) received PPIs and 88 (23%) did not. Only 31% had a clear indication for PPI use. PPI users had higher comorbidity and liver disease severity. Adjusted analysis showed no significant difference in all-cause mortality (29.9% vs 19.3%, p=0.67) or liver-related mortality (35.2% vs 17.6%, p=0.37). However, there were higher liver-related events (30.9% vs 10%, OR 2.9, p=0.046) and all-cause infections (30.9% vs 11.2%, OR 2.4, p=0.024).

CONCLUSION

PPI use in cirrhosis is linked to hepatic decompensation and higher infection risk. Judicious PPI use with clear indications is essential.