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There is increasing evidence that proton pump inhibitors (PPIs) increase the rate of infections in patients with decompensated cirrhosis. Dr Bajaj and colleagues from Virginia, USA estimated the extent to which proton pump inhibitors (PPIs) increase the rate of infections among patients with decompensated cirrhosis. The team conducted a retrospective propensity-matched new user design using US Veterans Health Administration data. Only decompensated cirrhotic patients from 2001 to 2009 were included. New PPI users after decompensation were matched equally to those who did not initiate gastric acid suppression. Serious infections, defined as infections associated with a hospitalization, were the outcomes.  | | 25% developed serious infections | | Alimentary Pharmacology & Therapeutics |
The research team separated these into acid suppression-related and non-acid suppression-related. Time-varying Cox models were used to estimate adjusted hazard ratios (HR) and 95% CIs of serious infections. Parallel analyses were conducted with H2 receptor antagonists (H2RA). The researchers found that more than half of persons with decompensated cirrhosis were new users of gastric acid suppressants, with most using PPIs compared with H2RAs. In the PPI propensity-matched analysis, 25% developed serious infections and, 26% developed serious infections in the H2RA analysis. PPI users developed serious infections faster than nongastric acid suppression users. For acid suppression-related serious infections, PPI users developed the outcome at a rate 1.75 times faster than non-users. The team noted that H2RA findings were not statistically significant. Dr Bajaj's team conclude, "Among patients with decompensated cirrhosis, proton pump inhibitors but not H2 receptor antagonists increase the rate of serious infections."
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