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All Studies   Meta Analysis       

Effect of Preadmission Proton Pump Inhibitor (PPI) on the clinical outcome of Covid-19 Hospitalised Patients during the Pandemic

Elkanzi et al., Academic Journal of Gastroenterology & Hepatology, doi:10.33552/AJGH.2023.03.000568
Nov 2023  
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Mortality -17% Improvement Relative Risk ICU admission -25% ASA 4 -126% ASA ≥3 -33% Hospitalization time 19% Proton Pump Inhibitors  Elkanzi et al.  Prophylaxis Is prophylaxis with proton pump inhibitors beneficial for COVID-19? Retrospective 309 patients in the United Kingdom Higher mortality (p=0.49) and ICU admission (p=0.053), not sig. c19early.org Elkanzi et al., Academic J. Gastroente.., Nov 2023 FavorsPPIs Favorscontrol 0 0.5 1 1.5 2+
PPIs for COVID-19
1st treatment shown to increase risk in September 2020, now with p = 0.00000012 from 39 studies.
5,100+ studies for 112 treatments. c19early.org
Retrospective 309 hospitalized patients showing higher risk of severe cases (ASA≥3) with PPI use.
risk of death, 17.1% higher, RR 1.17, p = 0.49, treatment 36 of 159 (22.6%), control 29 of 150 (19.3%).
risk of ICU admission, 24.9% higher, RR 1.25, p = 0.05, treatment 90 of 159 (56.6%), control 68 of 150 (45.3%).
ASA 4, 126.4% higher, RR 2.26, p = 0.14, treatment 12 of 159 (7.5%), control 5 of 150 (3.3%).
ASA ≥3, 32.6% higher, RR 1.33, p = 0.006, treatment 104 of 159 (65.4%), control 74 of 150 (49.3%).
hospitalization time, 19.0% lower, relative time 0.81, p = 0.18, treatment mean 9.8 (±13.1) n=159, control mean 12.1 (±16.6) n=150.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Elkanzi et al., 17 Nov 2023, retrospective, United Kingdom, peer-reviewed, 8 authors.
This PaperPPIsAll
Effect of Preadmission Proton Pump Inhibitor (PPI) on the clinical outcome of Covid-19 Hospitalised Patients during the Pandemic
Tasneem Elkanzi, Eugenia Ennin, Yks Viswanath, Awwab Shahid, Mustafa Omar, Rayan Mahmoud, Marwa Elhossary, Tan Ker
doi:10.33552/AJGH.2023.03.000568
COVID-19 has proved to be a severe disease since the end of 2019; according to WHO, over 600 million people have contracted this infection [1] . Most people who contracted this disease showed no symptoms. Initially, the mean hospitalisation period for symptomatic patients was 16 days, ranging between 3 to 45 days [2] . A significant complication of COVID-19 was found to be respiratory hypoxaemia, which accounted for up to 75% of hospital admissions secondary to pneumonia, along with acute respiratory disease (ARDS). While prodromal systems, such as fever, cough and shortness of breath, were seen in most symptomatic Covid patients, many system involvements were also observed. For instance, 19.7% of patients were found to have a cardiac injury [3] . Similarly, many systems involvements have been observed in SARS patients: 36.4% showed neurological manifestations of their disease [4], 19% had Abstract Methodology: Prospectively captured observational data was analyzed to include patients (>18 yr.) at the hospital with COVID-19 infection. PPI data was derived from hospital and primary care records, and the study period is between February 2020 and February 2021. Clinical outcomes of COVID-19 patients who were on proton pump inhibitors preadmission were compared with those of COVID-19 patients who were not on proton pump inhibitors simultaneously. The study's primary endpoint was 60-day mortality, intensive care unit admission, high dependency unit admission, and the development of COVID-19 complications. Additional endpoints included the length of critical care admission. Study type: Observational Cohort Study. Results: 309 patients were evaluated in this study; 159 were on proton pump inhibitors, and 150 were not on proton pump inhibitors at index admission. The mean length of stay was 9.8 in the PPI group and 12.1 in the non-PPI group. A slightly increased mortality rate of 22.6% in the PPI group compared with 19.3 % in the non-PPI group. Intensive Care Unit (ITU) and High Dependency Unit (HDU) admissions were higher in the PPI group (56.6%,30.8% respectively) than in the non-PPI group (45.3%,20.7%). Complications were more common in the PPI group74.8% had pulmonary complications, and 3.1% had thromboembolic complications. In the non-PPI group, 54% had pulmonary complications, which was over 20 % less than in the PPI group, 6% had thromboembolic complications, 1.93 times more than the PPI group. Conclusion: In Our study, PPI usage at index admission succeeded in showing worsening of outcomes in Covid 19 hospitalised patients, similar to recently published papers. This proposed causation needs further evaluation via well-conducted prospective studies.
are observational and thus, causality cannot be established. This proposed causation needs further evaluation via well-conducted prospective studies.
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