Use of proton pump inhibitors are associated with higher mortality in hospitalized patients with COVID-19.

Shengyong Wu,Chi Peng,Ronghui Zhu,Jia He,Dongdong Li,Yi Cheng,Zhichao Jin,Cheng Wu

doi:10.7189/jogh.12.05005

Abstract

BackgroundThe adverse effects of proton pump inhibitors (PPIs) on pneumonia have been well reported. However, the relationship between the use of PPIs and the adverse outcomes of coronavirus disease 2019 (COVID-19) is currently inconclusive. In this study, we aimed to explore the relationship between the use of PPIs and the in-hospital mortality among patients who were laboratory-confirmed SARS-CoV-2.MethodsData was derived from 2 hospitals which both were the first batch of SARS-CoV-2 specialist hospitals with four types of sensitivity analyses. This cohort included 4634 patients older than 18 years who were laboratory-confirmed SARS-CoV-2. Endpoints were death in hospital (primary) and the recovery of COVID-19 (secondary: the time of COVID-19 nucleic acid testing turning negative).ResultsIn the entire cohort, there were 3588 non-users, 399 ≤ 0.5 defined daily dose (DDD) PPIs users, 483 1 DDD users, and 164 ≥ 1.5 DDD users. The multivariate logistic regression analysis (odds ratio (OR) = 3.63, 95% confidence interval (CI) = 1.83-7.23, P = 0.0002) and four types of sensitivity analyses showed higher mortality in patients using PPIs during hospitalization, while the relationship between different PPIs dosages and the hospital mortality remained insignificant. Usage of the PPIs significantly prolongs the time of COVID-19 nucleic acid testing turning negative.ConclusionsThe use of PPIs may increase the risk of in-hospital death of patients who were laboratory-confirmed SARS-CoV-2, which means that physicians may need to re-evaluate the benefit-risk assessment of the use of PPIs during the COVID-19 pandemic.

Highlights

Correspondence to: Background The adverse effects of proton pump inhibitors (PPIs) on pneumonia have been well reported
The use of PPIs may increase the risk of in-hospital death of patients who were laboratory-confirmed SARS-CoV-2, which means that physicians may need to re-evaluate the benefit-risk assessment of the use of PPIs during the COVID-19 pandemic
There was significantly higher mortality (Table S2 in the Online Supplementary Document) in patients using PPIs during hospitalization compared with patients without use of PPIs (6.97% (73/1047) vs 0.53% (19/3604), P < 0.0001), and the use of PPIs was associated with an increased risk of death in multivariate logistic analysis (Table S3 in the Online Supplementary Document, OR = 3.63, 95% confidence interval (CI) = 1.83-7.23, P = 0.0002)