Impact of proton pump inhibitors on the in-hospital outcome of COVID-19 patients: a retrospective study
Haijuan Yao, Hongyu Li, Zhuang Ma, Yanyan Wu, Yufu Tang, Hao Meng, Hao Yu, Chengfei Peng, Yue Teng, Quanyu Zhang, Tianyi Zhu, Haitao Zhao, Guiyang Chu, Zhenhua Tong, Lu Liu, Hui Lu, Xingshun Qi
Therapeutic Advances in Gastroenterology, doi:10.1177/17562848221104365
Background: Coronavirus disease 2019 (COVID-19) has triggered a global public health crisis. Proton pump inhibitors (PPIs) are one of the most commonly prescribed drugs. However, the effect of PPIs on the clinical outcomes of COVID-19 patients remains unclear. Methods: All COVID-19 patients admitted to the Wuhan Huoshenshan Hospital from February 2020 to April 2020 were retrospectively collected. Patients were divided into PPIs and non-PPIs groups. Logistic regression analyses were performed to explore the effects of PPIs on the outcomes of COVID-19 patients, including transfer to intensive care unit, mechanical ventilation, and death. Subgroup analyses were performed according to the presence of upper gastrointestinal symptoms potentially associated with acid and the routes, types, median total dosage, and duration of PPIs. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results: Of the 3024 COVID-19 patients included, 694 and 2330 were in PPIs and non-PPIs groups, respectively. Univariate logistic regression analysis showed that PPIs significantly increased the risk of reaching the composite endpoint in COVID-19 patients (OR = 10.23, 95% CI = 6.90-15.16, p < 0.001). After adjusting for age, sex, comorbidities, other medications, and severe/critical COVID-19, PPIs were independently associated with an increased risk of reaching the composite endpoint (OR = 7.00, 95% CI = 4.57-10.71, p < 0.001). This association remained significant in patients with upper gastrointestinal symptoms and those who received an intravenous omeprazole alone, but not those who received oral lansoprazole or rabeprazole alone. It was not influenced by dosage or duration of PPIs.
Conclusion: The use of intravenous PPIs alone during hospitalization may be associated with worse clinical outcome in COVID-19 patients.
Authors' Note The abstract of the paper has been presented by two major authors as a poster at the 21st Congress of Gastroenterology China (CGC), which was published in 2021 in the Journal of Digestive Diseases (doi: 10.1111/1751-2980.13053).
Author contributions
ORCID iD Xingshun Qi https://orcid.org/0000-0002-9448-6739
Conflict of interest statement The authors declare that there is no conflict of interest.
Availability of data and material The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Supplemental material Supplemental material for this article is available online.
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