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Proton Pump Inhibitor Therapy Increases the Risk of Spontaneous Bacterial Peritonitis in Patients with HBV-Related Acute-on-Chronic Liver Failure

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Abstract

Introduction

Spontaneous bacterial peritonitis (SBP) is a common infection in patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF). SBP significantly increases the mortality rate and medical costs. The association between proton pump inhibitor (PPI) use and SBP remains unclear. We conducted a retrospective study to investigate the association between PPI use and SBP in patients with HBV-related ACLF and to explore the risk factors for SBP.

Methods

We compared the SBP incidence between the PPI and non-PPI groups before and after propensity score matching and explored the association between the duration and type of PPI and SBP occurrence. Risk factors for SBP occurrence were determined by univariate and multivariate logistic regression analysis.

Results

The SBP incidence was higher in the PPI group than in the non-PPI group before and after propensity score matching. The SBP incidence increased for elevated MELD scores in PPI users. There was a similar SBP incidence in both different types and durations of PPI users. MELD score, old age, male sex, and high WBC count were significant independent risk factors for SBP in PPI users with HBV-related ACLF in the hospital.

Conclusions

PPI therapy increases the risk of SBP development in patients with HBV-related ACLF. MELD score, old age, male sex, and high WBC count could serve as predictors of SBP in PPI users. Caution should be taken regarding PPI use, especially for patients with MELD scores > 30.

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Acknowledgements

Funding

No funding or sponsorship was received for this study or publication of this article. The Rapid Service Fee was funded by the authors.

Medical Writing Assistance

American Journal Experts (AJE) provided medical writing assistance for this paper; this was funded by the authors.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Authorship Contributions

Junying Qi and Tao Chen contributed to the study concept and design and contributed to the study supervision and critical revision of the manuscript for important content. Meng zhang contributed as first author and was involved in the analysis and interpretation of data, statistical analysis, and drafting of the manuscript. Meng Zhang, Xin Xu, Wei Liu, Zhongwei Zhang, Qiuyu Cheng, Zhongyuan Yang, Tingting Liu, and Yunhui Liu enrolled patients, collected clinical data, and assisted in the analysis and interpretation of clinical data. Qin Ning contributed to data re-evaluation and presentation, and manuscript edition.

Disclosures

All authors (Meng Zhang, Xin Xu, Wei Liu, Zhongwei Zhang, Qiuyu Cheng, Zhongyuan Yang, Tingting Liu, Yunhui Liu, Qin Ning, Tao Chen, and Junying Qi) have nothing to disclose.

Compliance with Ethics Guidelines

This study was approved by the Human Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology (2017-S312-2). Written informed consents were obtained from the patients.

Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095, Jiefang Avenue, Wuhan, 430030, People’s Republic of China

    Meng Zhang, Xin Xu, Wei Liu, Zhongwei Zhang, Qiuyu Cheng, Zhongyuan Yang, Tingting Liu, Yunhui Liu, Qin Ning, Tao Chen & Junying Qi

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  1. Meng Zhang
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Correspondence to Tao Chen or Junying Qi.

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Zhang, M., Xu, X., Liu, W. et al. Proton Pump Inhibitor Therapy Increases the Risk of Spontaneous Bacterial Peritonitis in Patients with HBV-Related Acute-on-Chronic Liver Failure. Adv Ther 38, 4675–4694 (2021). https://doi.org/10.1007/s12325-021-01844-1

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