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.