August 29, 2014
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PPI use increased risk for subsequent infections in patients with cirrhosis, existing infection

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Patients with cirrhosis and infections had a greater risk for subsequent infections within 6 months of hospital discharge when using proton pump inhibitors, according to new study data.

Jacqueline G. O’Leary, MD, MPH, medical director of the Liver and Transplant Unit at Annette C. & Harold C. Simmons Transplant Institute, Baylor University Medical Center, and colleagues conducted a prospective study of 188 patients hospitalized with cirrhosis and infections. Researchers analyzed data from the patients — enrolled in the North American Consortium for the Study of End-Stage Liver Disease — during a 6-month follow-up after discharge.

Jacqueline G. O'Leary

Patients who had subsequent infections after discharge vs. those without were older and most had used proton pump inhibitors (PPIs; 72.6% vs. 52.9%; P=.006), rifaximin (52.4% vs. 27.9%; P<.001) or prophylactic therapy for spontaneous bacterial peritonitis (SBP; 53.6% vs. 21.2%; P<.001).

“Proton pump inhibitor overuse is increasing the risk of infections in our cirrhotic patients and can easily be abated,” O’Leary told Healio.com/Hepatology.

Forty-five percent of patients experienced at least one subsequent infection requiring hospitalization during follow-up, and patients with second infections during index hospitalization who survived the 6-month follow-up had a 54% risk for subsequent infection. Multivariate logistic regression model showed SBP prophylaxis (OR=3.66; 95% CI, 1.6-8.37), PPI (OR=2.72; 95% CI, 1.3-5.71), SBP as an index infection (OR=0.37; 95% CI, 0.15-0.91) and age (OR=1.06; 95% CI, 1.02-1.11) were independent predictors of subsequent infections after factoring MELD score (OR=1.02; 95% CI, 0.96-1.07).

“The risk of subsequent infections cannot be predicted by just liver severity indices, but is increased in older patients with non-SBP index infections, especially if they are taking PPIs or SBP prophylaxis,” the researchers wrote. “Given the association with PPI use, its indication should be critically evaluated in all patients.”

Disclosure: The researchers report no relevant financial disclosures.