Abstract: Digestive and Liver Disease 52 (2020) 1410–1412
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Digestive and Liver Disease
journal homepage: www.elsevier.com/locate/dld
Correspondence
Proton pump inhibitor use is associated with increased
risk of severity and mortality from coronavirus disease
2019 (COVID-19) infection
Dear Editor,
World Health Organization (WHO) first declared coronavirus
disease 2019 (COVID-19) as a pandemic in March 2020, and now,
six months after that, the number of positive and death cases
are still increasing. This global pandemic has caused a significant
impact on health, social, and economic aspects around the world.
Thus, identification of the risk factors that contribute to the
development of severe infections is important to enabling risk
stratification, optimizing the hospital resources reallocation, and
guiding public health recommendations and interventions. Several
medications have been demonstrated to be associated with a
reduction in poor outcomes from COVID-19 such as anticoagulant
and metformin, while other medications did not alter outcomes of
COVID-19 infections such as ACE inhibitors, angiotensin II receptor
blocker (ARB), and statin [1-3]. During normal times, proton pump
inhibitors (PPIs) are among the drugs which are most commonly
used by patients because of their efficacy in relieving dyspepsia
and GERD symptoms, also because of their relatively affordable
price [4]. In a previous meta-analysis study, it has been shown that
the use of proton pump inhibitors (PPIs) may increase the risk of
pneumonia even though the heterogeneity of the study is high [5].
Unfortunately, until now, the evidence regarding the link between
the use of PPI and COVID-19 outcomes is still conflicting. This
article aims to give better evidence for the association between
PPI usage and in-hospital outcomes (severity and mortality) of
COVID-19 infection.
A search of the literature was conducted on Google scholar using the keywords “proton pump inhibitors” OR “PPI” OR “clinical
characteristics” OR “medications” OR “risk factors” AND “coronavirus disease 2019” OR “COVID-19”, between 2019 and present
time (September 10th, 2020) with language restricted to English
only. The title, abstract, and full text of all articles identified that
matched the search criteria were assessed, and those reporting the
rate of PPI usage in COVID-19 patients with a clinically validated
definition of “severe disease” and “mortality” were included in this
meta-analysis. The references of all identified studies were also analyzed (forward and backward citation tracking) to identify other
potentially eligible articles.
A meta-analysis was performed using Review Manager 5.4
(Cochrane Collaboration) software. Dichotomous variables were
calculated using the Mantel-Haenszel formula with random-effects
models. The heterogeneity was assessed by using the I2 statistic
with a value of < 25%, 26–50%, and > 50% were considered as
low, moderate, and high degrees of heterogeneity, respectively. The
effect estimate was reported as risk ratio (RR) along with its 95%
confidence intervals (CIs) for dichotomous variables, respectively.
P-value was two-tailed, and the statistical significance was set at
≤ 0.05.
A total of 7300 records were obtained through systematic electronic searches and other ways. After screening titles, abstracts,
and full texts, 6 studies [6-11] with a total of 5884 COVID-19 patients were included in the meta-analysis (Table 1). The individual
and pooled..
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