Association Between the Use of Proton Pump Inhibitors and Severe Clinical Outcomes in COVID-19 Patients: A Retrospective Observational Study
Sharon Pinto, Hadia Al Lawati, Marwa Al Raisi, Balqees Al Maawali
Cureus, doi:10.7759/cureus.72385
Background Proton pump inhibitors (PPIs) increase the risk of pneumonia secondary to PPI-induced hypochlorhydria. We aim to investigate the association between PPI and disease severity in coronavirus disease 2019 (COVID-19)-positive patients and the risk of hospitalizations in Muscat, Oman.
Methodology COVID-19-positive patients aged 18 years and above at the time of diagnosis were included in this retrospective observational study. The details of the patients were retrieved from the electronic health records of the Al Shifa Hospital Information Management System and Tarassud. The composite primary endpoint was COVID-19 admission to a government tertiary hospital ward or intensive care within 14 days of diagnosis.
Results A total of 506 COVID-19-positive patients were identified during the specified period. The mean age was 44 ± 15 years. The majority of the patients were Omani, and a female preponderance was observed. Overall, 104 (20.4%) patients were current PPI users. Admission due to COVID-19 was significantly associated with the presence of comorbid conditions such as diabetes mellitus (p = 0.001), hypertension (p = 0.001), and chronic kidney disease (p < 0.001). However, current PPI use (p = 0.140) was not significantly associated with an increased risk of hospitalization.
Conclusions This data suggests that the use of PPIs during COVID-19 infection did not increase the risk of severe COVID-19 infection and poor outcomes leading to hospitalization in Muscat, Oman. However, the presence of other medical comorbidities, such as diabetes and hypertension, was associated with a higher risk of adverse clinical symptoms that resulted in hospitalization.
Additional Information Author Contributions All authors have reviewed the final version to be published and agreed to be accountable for all aspects of the work.
Concept and design:
References
Almayahi, Raveendran, Malki, Clinical features, laboratory characteristics and risk factors for mortality of COVID-19 patients in a secondary hospital in Oman during the first wave of the SARS-CoV-2 pandemic, Bull Natl Res Cent,
doi:10.1186/s42269-022-00825-wChung, Palmer, Natale, Incidence and outcomes of COVID-19 in people with CKD: a systematic review and meta-analysis, Am J Kidney Dis,
doi:10.1053/j.ajkd.2021.07.003Gao, Piernas, Astbury, Hippisley-Cox, 'rahilly et al., Associations between body-mass index and COVID-19 severity in 6•9 million people in England: a prospective, community-based, cohort study, Lancet Diabetes Endocrinol,
doi:10.1016/S2213-8587(21)00089-9Hariyanto, Prasetya, Kurniawan, Proton pump inhibitor use is associated with increased risk of severity and mortality from coronavirus disease 2019 (COVID-19) infection, Dig Liver Dis,
doi:10.1016/j.dld.2020.10.001Harthi, Osali, Ismaili, Clinical characteristics of confirmed cases of COVID-19 admitted at Al Nahdha Hospital, Oman: a cross-sectional descriptive study, Cureus,
doi:10.7759/cureus.17343Hasan, Capstick, Ahmed, Kow, Mazhar et al., Mortality in COVID-19 patients with acute respiratory distress syndrome and corticosteroids use: a systematic review and meta-analysis, Expert Rev Respir Med,
doi:10.1080/17476348.2020.1804365Kariyawasam, Jayarajah, Riza, Abeysuriya, Seneviratne, Gastrointestinal manifestations in COVID-19, Trans R Soc Trop Med Hyg,
doi:10.1093/trstmh/trab042Khamis, Rashidi, Al-Zakwani, Wahaibi, Awaidy, Epidemiology of COVID-19 infection in Oman: analysis of the first 1304 cases, Oman Med J,
doi:10.5001/omj.2020.60Kuba, Imai, Ohto-Nakanishi, Penninger, Trilogy of ACE2: a peptidase in the renin-angiotensin system, a SARS receptor, and a partner for amino acid transporters, Pharmacol Ther,
doi:10.1016/j.pharmthera.2010.06.003Lee, Ha, Yeniova, Severe clinical outcomes of COVID-19 associated with proton pump inhibitors: a nationwide cohort study with propensity score matching, Gut,
doi:10.1136/gutjnl-2020-322248Maret-Ouda, Panula, Santoni, Xie, Lagergren, Proton pump inhibitor use and risk of pneumonia: a self-controlled case series study, J Gastroenterol,
doi:10.1007/s00535-023-02007-5Ramachandran, Perisetti, Gajendran, Louis, Bansal et al., Pre-hospitalization proton pump inhibitor use and clinical outcomes in COVID-19, Eur J Gastroenterol Hepatol,
doi:10.1097/MEG.0000000000002013Ray, Sharma, Sadasivam, The potential therapeutic role of proton pump inhibitors in COVID-19: hypotheses based on existing evidences, Drug Res (Stuttg),
doi:10.1055/a-1236-3041Shah, Halvorson, Mcbay, Proton-pump inhibitor use is not associated with severe COVID-19related outcomes: a propensity score-weighted analysis of a national veteran cohort, Gut,
doi:10.1136/gutjnl-2021-325701Shi, Wang, Ye, Predictors of mortality in patients with coronavirus disease 2019: a systematic review and meta-analysis, BMC Infect Dis,
doi:10.1186/s12879-021-06369-0Shupp, Mehta, Chirayath, Proton pump inhibitor therapy usage and associated hospitalization rates and critical care outcomes of COVID-19 patients, Sci Rep,
doi:10.1038/s41598-022-11680-0Tang, Chen, Yu, Chang, Chen et al., Effects of acupressure on fatigue of lung cancer patients undergoing chemotherapy: an experimental pilot study, Complement Ther Med,
doi:10.1016/j.ctim.2014.05.006Wahaibi, Rawahi, Patel, Khalili, Maani et al., COVID-19 disease severity and mortality determinants: a large population-based analysis in Oman, Travel Med Infect Dis,
doi:10.1016/j.tmaid.2020.101923Yao, Li, Ma, Impact of proton pump inhibitors on the in-hospital outcome of COVID-19 patients: a retrospective study, Therap Adv Gastroenterol,
doi:10.1177/17562848221104365Yip, Chan, Lui, Use of proton-pump inhibitor is not associated with adverse clinical outcomes in COVID-19 patients: a territory-wide cohort study, GastroHep,
doi:10.1155/2022/8803862Zeb, Almani, Arshad, Prevalence, mechanism, and implications of gastrointestinal symptoms in COVID-19, Pak J Med Health Sci,
doi:10.53350/pjmhs211582206Zhu, Hasegawa, Ma, Fujiogi, Camargo et al., Association of asthma and its genetic predisposition with the risk of severe COVID-19, J Allergy Clin Immunol,
doi:10.1016/j.jaci.2020.06.001{ 'indexed': { 'date-parts': [[2024, 10, 26]],
'date-time': '2024-10-26T04:23:03Z',
'timestamp': 1729916583719,
'version': '3.28.0'},
'reference-count': 26,
'publisher': 'Springer Science and Business Media LLC',
'content-domain': {'domain': [], 'crossmark-restriction': False},
'published-print': {'date-parts': [[2024, 10, 25]]},
'DOI': '10.7759/cureus.72385',
'type': 'journal-article',
'created': { 'date-parts': [[2024, 10, 25]],
'date-time': '2024-10-25T17:54:27Z',
'timestamp': 1729878867000},
'source': 'Crossref',
'is-referenced-by-count': 0,
'title': 'Association Between the Use of Proton Pump Inhibitors and Severe Clinical Outcomes in COVID-19 '
'Patients: A Retrospective Observational Study',
'prefix': '10.7759',
'author': [ {'given': 'Sharon', 'family': 'Pinto', 'sequence': 'first', 'affiliation': []},
{'given': 'Hadia', 'family': 'Al Lawati', 'sequence': 'additional', 'affiliation': []},
{'given': 'Marwa', 'family': 'Al Raisi', 'sequence': 'additional', 'affiliation': []},
{'given': 'Balqees Al', 'family': 'Maawali', 'sequence': 'additional', 'affiliation': []}],
'member': '297',
'reference': [ { 'key': 'ref1',
'doi-asserted-by': 'publisher',
'DOI': '10.1038/s41577-020-0308-3',
'article-title': 'COVID-19: immunopathology and its implications for therapy',
'volume': '20',
'author': 'Cao X',
'year': '2020',
'unstructured': 'Cao X. COVID-19: immunopathology and its implications for therapy. Nat '
'Rev Immunol. 2020, 20:269-70. 10.1038/s41577-020-0308-3',
'journal-title': 'Nat Rev Immunol'},
{ 'key': 'ref2',
'doi-asserted-by': 'publisher',
'DOI': '10.1002/jmv.25766',
'article-title': 'Coronavirus disease 2019: what we know?',
'volume': '92',
'author': 'He F',
'year': '2020',
'unstructured': 'He F, Deng Y, Li W. Coronavirus disease 2019: what we know?. J Med '
'Virol. 2020, 92:719-25. 10.1002/jmv.25766',
'journal-title': 'J Med Virol'},
{ 'key': 'ref3',
'doi-asserted-by': 'publisher',
'DOI': '10.1080/17476348.2020.1804365',
'article-title': 'Mortality in COVID-19 patients with acute respiratory distress syndrome '
'and corticosteroids use: a systematic review and meta-analysis',
'volume': '14',
'author': 'Hasan SS',
'year': '2020',
'unstructured': 'Hasan SS, Capstick T, Ahmed R, Kow CS, Mazhar F, Merchant HA, Zaidi ST. '
'Mortality in COVID-19 patients with acute respiratory distress syndrome '
'and corticosteroids use: a systematic review and meta-analysis. Expert '
'Rev Respir Med. 2020, 14:1149-63. 10.1080/17476348.2020.1804365',
'journal-title': 'Expert Rev Respir Med'},
{ 'key': 'ref4',
'doi-asserted-by': 'publisher',
'DOI': '10.5001/omj.2020.60',
'article-title': 'Epidemiology of COVID-19 infection in Oman: analysis of the first 1304 '
'cases',
'volume': '35',
'author': 'Khamis F',
'year': '2020',
'unstructured': 'Khamis F, Al Rashidi B, Al-Zakwani I, Al Wahaibi AH, Al Awaidy ST. '
'Epidemiology of COVID-19 infection in Oman: analysis of the first 1304 '
'cases. Oman Med J. 2020, 35:e145. 10.5001/omj.2020.60',
'journal-title': 'Oman Med J'},
{ 'key': 'ref5',
'doi-asserted-by': 'publisher',
'DOI': '10.1016/j.pharmthera.2010.06.003',
'article-title': 'Trilogy of ACE2: a peptidase in the renin-angiotensin system, a SARS '
'receptor, and a partner for amino acid transporters',
'volume': '128',
'author': 'Kuba K',
'year': '2010',
'unstructured': 'Kuba K, Imai Y, Ohto-Nakanishi T, Penninger JM. Trilogy of ACE2: a '
'peptidase in the renin-angiotensin system, a SARS receptor, and a '
'partner for amino acid transporters. Pharmacol Ther. 2010, 128:119-28. '
'10.1016/j.pharmthera.2010.06.003',
'journal-title': 'Pharmacol Ther'},
{ 'key': 'ref6',
'doi-asserted-by': 'publisher',
'DOI': '10.1053/j.gastro.2020.02.055',
'article-title': 'Evidence for gastrointestinal infection of SARS-CoV-2',
'volume': '158',
'author': 'Xiao F',
'year': '2020',
'unstructured': 'Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for '
'gastrointestinal infection of SARS-CoV-2. Gastroenterology. 2020, '
'158:1831-3.e3. 10.1053/j.gastro.2020.02.055',
'journal-title': 'Gastroenterology'},
{ 'key': 'ref7',
'doi-asserted-by': 'publisher',
'DOI': '10.1016/j.ctim.2014.05.006',
'article-title': 'Effects of acupressure on fatigue of lung cancer patients undergoing '
'chemotherapy: an experimental pilot study',
'volume': '22',
'author': 'Tang WR',
'year': '2014',
'unstructured': 'Tang WR, Chen WJ, Yu CT, Chang YC, Chen CM, Wang CH, Yang SH. Effects of '
'acupressure on fatigue of lung cancer patients undergoing chemotherapy: '
'an experimental pilot study. Complement Ther Med. 2014, 22:581-91. '
'10.1016/j.ctim.2014.05.006',
'journal-title': 'Complement Ther Med'},
{ 'key': 'ref8',
'doi-asserted-by': 'publisher',
'DOI': '10.1093/trstmh/trab042',
'article-title': 'Gastrointestinal manifestations in COVID-19',
'volume': '115',
'author': 'Kariyawasam JC',
'year': '2021',
'unstructured': 'Kariyawasam JC, Jayarajah U, Riza R, Abeysuriya V, Seneviratne SL. '
'Gastrointestinal manifestations in COVID-19. Trans R Soc Trop Med Hyg. '
'2021, 115:1362-88. 10.1093/trstmh/trab042',
'journal-title': 'Trans R Soc Trop Med Hyg'},
{ 'key': 'ref9',
'doi-asserted-by': 'publisher',
'DOI': '10.53350/pjmhs211582206',
'article-title': 'Prevalence, mechanism, and implications of gastrointestinal symptoms in '
'COVID-19',
'volume': '15',
'author': 'Zeb S',
'year': '2021',
'unstructured': 'Zeb S, Almani K, Arshad I, et al.. Prevalence, mechanism, and '
'implications of gastrointestinal symptoms in COVID-19. Pak J Med Health '
'Sci. 2021, 15:2206-9. 10.53350/pjmhs211582206',
'journal-title': 'Pak J Med Health Sci'},
{ 'key': 'ref10',
'doi-asserted-by': 'publisher',
'DOI': '10.1136/gutjnl-2020-322248',
'article-title': 'Severe clinical outcomes of COVID-19 associated with proton pump '
'inhibitors: a nationwide cohort study with propensity score matching',
'volume': '70',
'author': 'Lee SW',
'year': '2021',
'unstructured': 'Lee SW, Ha EK, Yeniova AÖ, et al.. Severe clinical outcomes of COVID-19 '
'associated with proton pump inhibitors: a nationwide cohort study with '
'propensity score matching. Gut. 2021, 70:76-84. '
'10.1136/gutjnl-2020-322248',
'journal-title': 'Gut'},
{ 'key': 'ref11',
'doi-asserted-by': 'publisher',
'DOI': '10.1097/MEG.0000000000002013',
'article-title': 'Pre-hospitalization proton pump inhibitor use and clinical outcomes in '
'COVID-19',
'volume': '34',
'author': 'Ramachandran P',
'year': '2022',
'unstructured': 'Ramachandran P, Perisetti A, Gajendran M, Jean-Louis F, Bansal P, '
'Dwivedi AK, Goyal H. Pre-hospitalization proton pump inhibitor use and '
'clinical outcomes in COVID-19. Eur J Gastroenterol Hepatol. 2022, '
'34:137-41. 10.1097/MEG.0000000000002013',
'journal-title': 'Eur J Gastroenterol Hepatol'},
{ 'key': 'ref12',
'doi-asserted-by': 'publisher',
'DOI': '10.1152/physrev.00016.2019',
'article-title': 'The physiology of the gastric parietal cell',
'volume': '100',
'author': 'Engevik AC',
'year': '2020',
'unstructured': 'Engevik AC, Kaji I, Goldenring JR. The physiology of the gastric '
'parietal cell. Physiol Rev. 2020, 100:573-602. '
'10.1152/physrev.00016.2019',
'journal-title': 'Physiol Rev'},
{ 'key': 'ref13',
'doi-asserted-by': 'publisher',
'DOI': '10.1055/a-1236-3041',
'article-title': 'The potential therapeutic role of proton pump inhibitors in COVID-19: '
'hypotheses based on existing evidences',
'volume': '70',
'author': 'Ray A',
'year': '2020',
'unstructured': 'Ray A, Sharma S, Sadasivam B. The potential therapeutic role of proton '
'pump inhibitors in COVID-19: hypotheses based on existing evidences. '
'Drug Res (Stuttg). 2020, 70:484-8. 10.1055/a-1236-3041',
'journal-title': 'Drug Res (Stuttg)'},
{ 'key': 'ref14',
'doi-asserted-by': 'publisher',
'DOI': '10.1016/j.dld.2020.10.001',
'article-title': 'Proton pump inhibitor use is associated with increased risk of severity '
'and mortality from coronavirus disease 2019 (COVID-19) infection',
'volume': '52',
'author': 'Hariyanto TI',
'year': '2020',
'unstructured': 'Hariyanto TI, Prasetya IB, Kurniawan A. Proton pump inhibitor use is '
'associated with increased risk of severity and mortality from '
'coronavirus disease 2019 (COVID-19) infection. Dig Liver Dis. 2020, '
'52:1410-2. 10.1016/j.dld.2020.10.001',
'journal-title': 'Dig Liver Dis'},
{ 'key': 'ref15',
'doi-asserted-by': 'publisher',
'DOI': '10.1007/s00535-023-02007-5',
'article-title': 'Proton pump inhibitor use and risk of pneumonia: a self-controlled case '
'series study',
'volume': '58',
'author': 'Maret-Ouda J',
'year': '2023',
'unstructured': 'Maret-Ouda J, Panula J, Santoni G, Xie S, Lagergren J. Proton pump '
'inhibitor use and risk of pneumonia: a self-controlled case series '
'study. J Gastroenterol. 2023, 58:734-40. 10.1007/s00535-023-02007-5',
'journal-title': 'J Gastroenterol'},
{ 'key': 'ref16',
'doi-asserted-by': 'publisher',
'DOI': '10.1136/gutjnl-2021-325701',
'article-title': 'Proton-pump inhibitor use is not associated with severe '
'COVID-19-related outcomes: a propensity score-weighted analysis of a '
'national veteran cohort',
'volume': '71',
'author': 'Shah S',
'year': '2022',
'unstructured': 'Shah S, Halvorson A, McBay B, et al.. Proton-pump inhibitor use is not '
'associated with severe COVID-19-related outcomes: a propensity '
'score-weighted analysis of a national veteran cohort. Gut. 2022, '
'71:1447-50. 10.1136/gutjnl-2021-325701',
'journal-title': 'Gut'},
{ 'key': 'ref17',
'doi-asserted-by': 'publisher',
'DOI': '10.1155/2022/8803862',
'article-title': 'Use of proton-pump inhibitor is not associated with adverse clinical '
'outcomes in COVID-19 patients: a territory-wide cohort study',
'volume': '13',
'author': 'Yip TC',
'year': '2022',
'unstructured': 'Yip TC, Chan FK, Lui GC, et al.. Use of proton-pump inhibitor is not '
'associated with adverse clinical outcomes in COVID-19 patients: a '
'territory-wide cohort study. GastroHep. 2022, 13:1-13. '
'10.1155/2022/8803862',
'journal-title': 'GastroHep'},
{ 'key': 'ref18',
'doi-asserted-by': 'publisher',
'DOI': '10.1038/s41598-022-11680-0',
'article-title': 'Proton pump inhibitor therapy usage and associated hospitalization '
'rates and critical care outcomes of COVID-19 patients',
'volume': '12',
'author': 'Shupp B',
'year': '2022',
'unstructured': 'Shupp B, Mehta SV, Chirayath S, et al.. Proton pump inhibitor therapy '
'usage and associated hospitalization rates and critical care outcomes of '
'COVID-19 patients. Sci Rep. 2022, 12:7596. 10.1038/s41598-022-11680-0',
'journal-title': 'Sci Rep'},
{ 'key': 'ref19',
'doi-asserted-by': 'publisher',
'DOI': '10.1177/17562848221104365',
'article-title': 'Impact of proton pump inhibitors on the in-hospital outcome of COVID-19 '
'patients: a retrospective study',
'volume': '15',
'author': 'Yao H',
'year': '2022',
'unstructured': 'Yao H, Li H, Ma Z, et al.. Impact of proton pump inhibitors on the '
'in-hospital outcome of COVID-19 patients: a retrospective study. Therap '
'Adv Gastroenterol. 2022, 15:17562848221104365. 10.1177/17562848221104365',
'journal-title': 'Therap Adv Gastroenterol'},
{ 'key': 'ref20',
'doi-asserted-by': 'publisher',
'DOI': '10.1186/s42269-022-00825-w',
'article-title': 'Clinical features, laboratory characteristics and risk factors for '
'mortality of COVID-19 patients in a secondary hospital in Oman during '
'the first wave of the SARS-CoV-2 pandemic',
'volume': '46',
'author': 'Almayahi ZK',
'year': '2022',
'unstructured': 'Almayahi ZK, Raveendran AV, Al Malki R, et al.. Clinical features, '
'laboratory characteristics and risk factors for mortality of COVID-19 '
'patients in a secondary hospital in Oman during the first wave of the '
'SARS-CoV-2 pandemic. Bull Natl Res Cent. 2022, 46:139. '
'10.1186/s42269-022-00825-w',
'journal-title': 'Bull Natl Res Cent'},
{ 'key': 'ref21',
'doi-asserted-by': 'publisher',
'DOI': '10.7759/cureus.17343',
'article-title': 'Clinical characteristics of confirmed cases of COVID-19 admitted at Al '
'Nahdha Hospital, Oman: a cross-sectional descriptive study',
'volume': '13',
'author': 'Al Harthi S',
'year': '2021',
'unstructured': 'Al Harthi S, Al Osali M, Al Ismaili R, et al.. Clinical characteristics '
'of confirmed cases of COVID-19 admitted at Al Nahdha Hospital, Oman: a '
'cross-sectional descriptive study. Cureus. 2021, 13:e17343. '
'10.7759/cureus.17343',
'journal-title': 'Cureus'},
{ 'key': 'ref22',
'doi-asserted-by': 'publisher',
'DOI': '10.1016/j.jaci.2020.06.001',
'article-title': 'Association of asthma and its genetic predisposition with the risk of '
'severe COVID-19',
'volume': '146',
'author': 'Zhu Z',
'year': '2020',
'unstructured': 'Zhu Z, Hasegawa K, Ma B, Fujiogi M, Camargo CA Jr, Liang L. Association '
'of asthma and its genetic predisposition with the risk of severe '
'COVID-19. J Allergy Clin Immunol. 2020, 146:327-9.e4. '
'10.1016/j.jaci.2020.06.001',
'journal-title': 'J Allergy Clin Immunol'},
{ 'key': 'ref23',
'doi-asserted-by': 'publisher',
'DOI': '10.1186/s12879-021-06369-0',
'article-title': 'Predictors of mortality in patients with coronavirus disease 2019: a '
'systematic review and meta-analysis',
'volume': '21',
'author': 'Shi C',
'year': '2021',
'unstructured': 'Shi C, Wang L, Ye J, et al.. Predictors of mortality in patients with '
'coronavirus disease 2019: a systematic review and meta-analysis. BMC '
'Infect Dis. 2021, 21:663. 10.1186/s12879-021-06369-0',
'journal-title': 'BMC Infect Dis'},
{ 'key': 'ref24',
'doi-asserted-by': 'publisher',
'DOI': '10.1053/j.ajkd.2021.07.003',
'article-title': 'Incidence and outcomes of COVID-19 in people with CKD: a systematic '
'review and meta-analysis',
'volume': '78',
'author': 'Chung EY',
'year': '2021',
'unstructured': 'Chung EY, Palmer SC, Natale P, et al.. Incidence and outcomes of '
'COVID-19 in people with CKD: a systematic review and meta-analysis. Am J '
'Kidney Dis. 2021, 78:804-15. 10.1053/j.ajkd.2021.07.003',
'journal-title': 'Am J Kidney Dis'},
{ 'key': 'ref25',
'doi-asserted-by': 'publisher',
'DOI': '10.1016/S2213-8587(21)00089-9',
'article-title': 'Associations between body-mass index and COVID-19 severity in 6·9 '
'million people in England: a prospective, community-based, cohort study',
'volume': '9',
'author': 'Gao M',
'year': '2021',
'unstructured': "Gao M, Piernas C, Astbury NM, Hippisley-Cox J, O'Rahilly S, Aveyard P, "
'Jebb SA. Associations between body-mass index and COVID-19 severity in '
'6·9 million people in England: a prospective, community-based, cohort '
'study. Lancet Diabetes Endocrinol. 2021, 9:350-9. '
'10.1016/S2213-8587(21)00089-9',
'journal-title': 'Lancet Diabetes Endocrinol'},
{ 'key': 'ref26',
'doi-asserted-by': 'publisher',
'DOI': '10.1016/j.tmaid.2020.101923',
'article-title': 'COVID-19 disease severity and mortality determinants: a large '
'population-based analysis in Oman',
'volume': '39',
'author': 'Al Wahaibi A',
'year': '2021',
'unstructured': 'Al Wahaibi A, Al Rawahi B, Patel PK, Al Khalili S, Al Maani A, Al-Abri '
'S. COVID-19 disease severity and mortality determinants: a large '
'population-based analysis in Oman. Travel Med Infect Dis. 2021, '
'39:101923. 10.1016/j.tmaid.2020.101923',
'journal-title': 'Travel Med Infect Dis'}],
'container-title': 'Cureus',
'original-title': [],
'language': 'en',
'link': [ { 'URL': 'https://www.cureus.com/articles/310267-association-between-the-use-of-proton-pump-inhibitors-and-severe-clinical-outcomes-in-covid-19-patients-a-retrospective-observational-study',
'content-type': 'unspecified',
'content-version': 'vor',
'intended-application': 'similarity-checking'}],
'deposited': { 'date-parts': [[2024, 10, 25]],
'date-time': '2024-10-25T17:54:28Z',
'timestamp': 1729878868000},
'score': 1,
'resource': { 'primary': { 'URL': 'https://www.cureus.com/articles/310267-association-between-the-use-of-proton-pump-inhibitors-and-severe-clinical-outcomes-in-covid-19-patients-a-retrospective-observational-study'}},
'subtitle': [],
'short-title': [],
'issued': {'date-parts': [[2024, 10, 25]]},
'references-count': 26,
'URL': 'http://dx.doi.org/10.7759/cureus.72385',
'relation': {},
'ISSN': ['2168-8184'],
'subject': [],
'published': {'date-parts': [[2024, 10, 25]]}}
