Prehospitalization Proton Pump Inhibitor (PPI) use and Clinical Outcomes in COVID-19

Abstract

Introduction There is a concern that proton pump inhibitors (PPI) induced hypochlorhydria could potentially predispose to severe COVID-19. Methods We studied the association between prehospitalization PPI use and clinical outcomes among hospitalized COVID-19 patients. Results In our study, 15.6% of hospitalized COVID-19 patients were on PPI. Mortality among PPI-users was 2.3 times higher than non-users, along with 2.5 times higher risk of mechanical ventilation. This relationship existed even after adjusting for confounding variables. Discussion These results warrant further investigation to evaluate if PPI-induced hypochlorhydria is associated with a higher risk of GI symptoms and worse outcomes because of the omnipresence of ACE-2 in the gastrointestinal tract.

Do proton pump inhibitors influence SARS-CoV-2 related outcomes? A meta-analysis

“…These results were consistent with our leaveone-out sensitivity analysis (online supplemental figure 4), indicating that this association was strong. Furthermore, current PPI users tended to hospitalised longer than PPI non-users, although not by a statistically significant margin (n=353 from two studies; 7 14 MD 1.13, 95% CI −0.18 to 2.43, p=0.09; figure 2). Finally, past use of PPIs was not associated with increased susceptibility to SARS-CoV-2 infection (n=1 72 833 from four studies; 1 3 5 6 OR 0.85, 95% CI 0.57 to 1.27, p=0.43; I 2 =92%; figure 1) or with severe outcomes of COVID-19 (n=40 097 from three studies; 1 3 9 OR 1.03, 95% CI 0.85 to 1.23, p=0.79; I 2 =0%; figure 2).…”

Inflammatory bowel disease amid the COVID-19 pandemic: impact, management strategies, and lessons learned

“…Table 1 outlines the risk factors for COVID-19 infection and poor outcomes [ 2 - 4 , 7 , 13 , 51 ]. Recent evidence suggests that the use of proton pump inhibitors is associated with an increased risk of SARS-CoV-2 infection and also potentially increases the risk of poor outcomes, such as death and mechanical ventilation [ 52 , 53 ].…”

Use of proton pump inhibitors and risk of adverse clinical outcomes from COVID‐19: a meta‐analysis

“…The pooled analysis of studies by McKeigue et al [5], Ramachandran et al [6] and Lee et al [4] revealed a significantly increased odds for a severe or fatal course of COVID-19 with the use of PPIs in COVID-19 patients relative to nonuse of PPIs ( Fig. 1; pooled OR = 1.46; 95% CI 1.34-1.60).…”

“…Five studies that corresponded to inclusion criteria with a total of 37 372 patients were included for our meta-analysis [1,[4][5][6]. Study characteristics are depicted in Table 1.…”

“…Letter to the Editor In the study by McKeigue et al [4], the adverse clinical outcome was defined as entry to critical care or death within 28 days or a death certificate with COVID-19 as underlying cause; in the study by Ramachandran et al [5], the adverse clinical outcome was defined as in-hospital mortality and requirement for mechanical ventilation; in the study by Lee et al [1], we utilized the composite endpoint of requirement of oxygen therapy, intensive care unit admission, administration of invasive ventilation or death to define adverse clinical outcome; in the study by Luxenburger et al [6] and Li et al [7], the adverse clinical outcome was defined as development of secondary infection.…”