DOI record:
{
"DOI": "10.14309/ajg.0000000000001311",
"ISSN": [
"0002-9270",
"1572-0241"
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"URL": "http://dx.doi.org/10.14309/ajg.0000000000001311",
"abstract": "<jats:sec>\n <jats:title>INTRODUCTION:</jats:title>\n <jats:p>Proton pump inhibitor (PPI) use was recently reported to be associated with increased severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and worse clinical outcomes. The underlying mechanism(s) for this association are unclear.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>METHODS:</jats:title>\n <jats:p>We performed a prospective study of hospitalized coronavirus disease 2019 (COVID-19) patients and COVID-negative controls to understand how PPI use may affect angiotensin-converting enzyme 2 (ACE2) expression and stool SARS-CoV-2 RNA. Analysis of a retrospective cohort of hospitalized patients with COVID-19 from March 15, 2020 to August 15, 2020 in 6 hospitals was performed to evaluate the association of PPI use and mortality. Covariates with clinical relevance to COVID-19 outcomes were included to determine predictors of in-hospital mortality.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>RESULTS:</jats:title>\n <jats:p>Control PPI users had higher salivary <jats:italic toggle=\"yes\">ACE2</jats:italic> mRNA levels than nonusers, 2.39 ± 1.15 vs 1.22 ± 0.92 (<jats:italic toggle=\"yes\">P</jats:italic> = 0.02), respectively. Salivary ACE2 levels and stool SARS-CoV-2 RNA detection rates were comparable between users and nonusers of PPI. In 694 hospitalized patients with COVID-19 (age = 58 years, 46% men, and 65% black), mortality rate in PPI users and nonusers was 30% (68/227) vs 12.1% (53/439), respectively. Predictors of mortality by logistic regression were PPI use (adjusted odds ratio [aOR] = 2.72, <jats:italic toggle=\"yes\">P</jats:italic> < 0.001), age (aOR = 1.66 per decade, <jats:italic toggle=\"yes\">P</jats:italic> < 0.001), race (aOR = 3.03, <jats:italic toggle=\"yes\">P</jats:italic> = 0.002), cancer (aOR = 2.22, <jats:italic toggle=\"yes\">P</jats:italic> = 0.008), and diabetes (aOR = 1.95, <jats:italic toggle=\"yes\">P</jats:italic> = 0.003). The PPI-associated mortality risk was higher in black patients (aOR = 4.16, 95% confidence interval: 2.28–7.59) than others (aOR = 1.62, 95% confidence interval: 0.82–3.19, <jats:italic toggle=\"yes\">P</jats:italic> = 0.04 for interaction).</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>DISCUSSION:</jats:title>\n <jats:p>COVID-negative PPI users had higher salivary <jats:italic toggle=\"yes\">ACE2</jats:italic> expression. PPI use was associated with increased mortality risk in patients with COVID-19, particularly African Americans.</jats:p>\n </jats:sec>",
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