Effect of proton pump inhibitors in hospitalization on mortality of patients with hepatic encephalopathy and cirrhosis but no active gastrointestinal bleeding

Abstract

Hepatic encephalopathy (HE) is a neuropsychiatric complication of decompensated cirrhosis. Proton pump inhibitors (PPIs), used as potent acid suppressants, are associated with HE occurrence in cirrhotic patients. However, it is still unknown if PPIs contribute to mortality in cirrhotic patients with HE and no active gastrointestinal bleeding. We used the Taiwan National Health Insurance Database to identify 1004 cirrhotic patients with HE and no active gastric bleeding, who received oral PPIs between January 1, 2010 and December 31, 2013. On the basis of comorbid disorder data, we used propensity score matching at a 1:4 ratio to select 4016 cirrhotic patients with HE and no active gastric bleeding who did not receive PPIs as a comparison group. All patients were followed up for one year from the index time. The overall 30-day, 90-day, and 1-year mortalities were 36.1%, 52.6%, and 70.1% in PPI group, and 27.5%, 41.7%, and 62.4% in non-PPI group. Using Cox regression model analysis with adjustment for age, gender, and other comorbid disorders, we obtained hazard ratios of 1.360 (95% CI: 1.208-1.532, P<0.001), 1.563 (95% CI: 1.314-1.859; P<0.001), and 1.187 (95% CI: 1.008-1.398; P=0.040) for, respectively, 30-day, 30-day to 90-day, and 90-day to 1-year mortality in patients taking PPIs. PPIs increase short-term and long-term mortality of cirrhotic patients with HE and no active gastrointestinal bleeding.