Effect of proton pump inhibitor on the occurrence of overt hepatic encephalopathy in patients with liver cirrhosis
10.3760/cma.j.cn311367-20240624-00243
- VernacularTitle:质子泵抑制剂对肝硬化患者发生显性肝性脑病的影响
- Author:
Hongfei ZHAN
1
;
Jinhan HU
1
;
Lingyan CAI
1
;
Xin ZENG
1
Author Information
1. 上海市东方医院（同济大学附属东方医院）消化内科，上海 200120
- Publication Type:Journal Article
- Keywords:
Proton pump inhibitor;
Liver cirrhosis;
Overt hepatic encephalopathy;
Risk factor;
Prognosis
- From:
Chinese Journal of Digestion
2024;44(11):763-768
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the risk factors of the occurrence of overt hepatic encephalopathy (OHE) in patients with liver cirrhosis and the effect of proton pump inhibitor (PPI) on OHE.Methods:This study was led by the Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital) and Shanghai East Hospital of Tongji University School of Medicine, and a total of 13 hospitals participated. From July 31, 2020 to December 10, 2021, a total of 184 liver cirrhosis patients without prior OHE and with ≥2-year follow-up from the above 2 leading hospitals, and other hospitals such as Guangzhou Eighth People′s Hospital of Guangzhou Medical University and Affiliated Hospital of Zunyi Medical University were enrolled. According to whether OHE occurred during the 2-year follow-up period, the 184 patients were divided into OHE group (22 cases) and non-OHE group (162 cases). The clinical data of all the patients were collected, including the laboratory parameters such as international normalized ratio (INR), the usage of PPI, the occurrence of gastrointestinal bleeding, infection, liver cancer and other complications, and survival status. Multivariate logistic regression model was used to analyze the independent risk factors for OHE in patients with liver cirrhosis. Kaplan-Meier survival curve was performed to analyze the effect of PPI on the survival rate of patients with liver cirrhosis. Chi-square test and Cochran-Mantel-Haenszel test were used for statistical analysis.Results:The result of multivariate logistic regression analysis showed that INR ( OR=11.331, 95% confidence interval (95% CI) 2.415 to 53.156, P =0.002) and PPI ( OR=6.794, 95% CI 2.359 to 19.567, P<0.001) were independent risk factors for OHE in patients with liver cirrhosis. The rate of PPI usage of the OHE group was higher than that of the non-OHE group (72.7%, 16/22 vs. 30.9%, 50/162), and the difference was statistically significant ( χ2=14.76, P<0.001). After the patients with gastrointestinal bleeding, infection and liver diseases-related deaths were excluded respectively, the rates of PPI usage of the OHE group were still higher than that of the non-OHE group (8/12 vs. 21.3%, 27/127; 11/16 vs. 25.0%, 35/140; 12/15 vs. 29.0%, 45/155), and the differences were all statistically significant ( χ2=9.71, 11.20 and 15.94; all P<0.01). Kaplan-Meier survival curve analysis showed that the 2-year cumulative survival rate of liver cirrhosis patients with PPI usage was lower than that of the patients without PPI usage (86.4%, 57/66 vs. 95.8%, 113/118), and the difference was statistically significant ( χ2=5.37, P =0.020). Conclusion:PPI is an independent risk factor for OHE in patients with liver cirrhosis, and may increase the risk of liver disease-related death.
