The relationship between proton pump inhibitor and the risk of spontaneous bacterial peritonitis in cirrhotic patients: a meta-analysis

Abstract

Objective To evaluate the relationship between proton pump inhibitor (PPI) and the risk of spontaneous bacterial peritonitis (SBP) in cirrhosis patients systematically. Methods The literature on the related databases as of February 2019 was searched. Case-control studies, cohort studies, and randomized controlled studies (RCT), which set the theme as the relationship between PPI and SBP in cirrhosis patients, whose main outcome indicator was SBP incidence, and which had high quality assessed by Newcastle-Ottawa Scale or modified Jadad scoring method, were collected. The meta-analysis was performed using Rev Man 5.3 software. Results A total of 18 studies were enrolled in the meta-analysis. Of the 18 studies, 8 were case-control studies, 9 were cohort studies, and 1 was RCT; 6 were prospective studies and 12 were retrospective studies; 13 were single-center studies and 5 were multi-center studies. A total of 6 961 patients were included, 3 353 in the trial group and 3 608 in the control group. The patients in the trial group received PPI alone and the patients in the control group did not receive any acid-suppressing drug. Overall analysis of the 18 studies showed that the risk of SBP in patients in the trial group was markedly higher than that in the control group (OR=1.83, 95%CI: 1.43-2.33, P<0.001). The results of subgroup analysis for 8 case-control studies showed that the risk of SBP in patients in the trial group was markedly higher than that in the control group(OR=2.38, 95%CI: 1.69-3.36, P<0.001). The results of subgroup analysis for 9 cohort studies showed that the risk of SBP of patients in the trial group was markedly higher than that in the control group (OR=1.27, 95%CI: 1.04-1.55, P=0.020). The results of subgroup analysis for 12 retrospective studies showed that the risk of SBP in patients in the trial group was markedly higher than that in the control group (OR=1.81, 95%CI: 1.34-2.45, P=0.001). The results of subgroup analysis for 6 perspective studies showed that the risk of SBP in patients in the trial group was markedly higher than that in the control group (OR=1.88, 95%CI: 1.27-2.79, P=0.002). The results of subgroup analysis for 13 single-center studies showed that the risk of SBP in patients in the trial group was markedly higher than that in the control group (OR=1.97, 95%CI: 1.41-2.76, P<0.001). The results of subgroup analysis for 5 multicenter studies showed that the risk of SBP in patients in the trial group was markedly higher than that in the control group (OR=1.69, 95%CI: 1.33-2.13, P<0.001). Conclusions PPI can increase the risk of SBP in patients with liver cirrhosis. It is suggested that PPI be used cautiously in patients with liver cirrhosis. Key words: Proton pump inhibitors; Liver cirrhosis; Peritonitis; Meta-analysis