In a retrospective study to evaluate the impact of proton pump inhibitors (PPIs) on all-cause mortality in patients with cirrhosis, researchers found reduced mortality only in those hospitalized for gastrointestinal bleeding. They reported increased liver-related mortality associated with PPIs in all other patients with cirrhosis.
Patients on PPIs had an 18% reduction in all-cause mortality vs other patients if they had gastrointestinal bleeding. But in those without bleeding, PPIs were associated with a 23% increase in liver-related mortality.
Further analysis suggested that the mortality increase could be related to a 21% increased risk for severe infection with PPI exposure in patients with cirrhosis, as well as a 64% increased risk for decompensation.
"My take-away from this study is that there should be a nuanced understanding of PPIs and cirrhosis," corresponding author Nadim Mahmud, MD, MS, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, told Medscape Medical News, adding that, if they are to be used in this setting, there should be "a very compelling indication."
Based on the new analysis, Mahmud explained, in a patient with cirrhosis hospitalized with a potentially ulcer-related upper gastrointestinal bleed, "we shouldn't be afraid" to use PPIs "out of fear of potential infection or decompensation because our data demonstrate pretty strongly that that sort of patient may have a mortality benefit."
