S1366 Association Between Proton Pump Inhibitor Use and COVID-19 Related Hospitalization Outcomes

Abstract

INTRODUCTION: Coronavirus disease 2019 (COVID-19) can cause systemic, respiratory, and gastrointestinal manifestations, with many patients requiring mechanical ventilation and ICU-level care. Proton-pump inhibitor (PPI) use has previously been linked to increased hospital-acquired and ventilator-associated pneumonias, although a causative relationship remains debated. The effect of PPI use in COVID-19 outcomes in unknown. We aimed to evaluate the relationship between PPI exposure and clinical outcomes of hospitalized COVID-19 patients. METHODS: This was a retrospective cohort study of consecutive adults hospitalized across nine US centers with COVID-19. The primary outcome measure was the need for mechanical ventilation in patients with and without PPI exposure during their non-ICU ward stay. The secondary outcome measure was in-hospital, all-cause mortality among patients with and without any PPI exposure. PPI use was further stratified by dosage and timing of initiation. Univariate analyses were performed using student’s t-test and Fisher’s exact test, and multivariable analyses were performed using logistic regression. RESULTS: A total of 389 patients were included (mean age 62.9 years, 43.7% women), with 138 (35.5%) receiving PPI, 161 (41.3%) ICU admissions, and 57 (15.0%) deaths. PPI exposure during non-ICU ward stay correlated with increased need for mechanical ventilation [aOR 2.31 (95% CI: 1.28–4.18); P = 0.0057] after controlling for potential confounders (Table 1). For our secondary analysis, PPI use was associated with higher in-hospital, all-cause mortality [aOR 2.13 (95% CI: 1.10–4.14); P = 0.027] (Table 2). When stratified by dosage, high-dose PPI use, but not low-dose use, remained an independent predictor of both outcomes (Tables 1 and 2). CONCLUSION: PPI use among hospitalized COVID-19 patients was independently associated with greater need for mechanical ventilation and increased mortality. Further studies are needed to determine whether this indicates a causal relationship, or whether PPI use represents underlying GERD or other comorbidities with prognostic implications.Table 1.: Multivariable regression models for the need for mechanical ventilation among patients with and without PPI exposure during their non-ICU ward stayTable 2.: Multivariable regression models for in-hospital, all-cause mortality among patients with and without any PPI exposure