Use of proton pump inhibitors are associated with higher mortality in hospitalized patients with COVID-19

Abstract

Background The adverse effects of proton pump inhibitors (PPIs) on pneumonia have been well reported. However, the relationship between the use of PPIs and the adverse outcomes of coronavirus disease 2019 (COVID-19) is currently inconclusive. In this study, we aimed to explore the relationship between the use of PPIs and the in-hospital mortality among patients who were laboratory-confirmed SARS-CoV-2. Methods Data was derived from 2 hospitals which both were the first batch of SARS-CoV-2 specialist hospitals with four types of sensitivity analyses. This cohort included 4634 patients older than 18 years who were laboratory-confirmed SARS-CoV-2. Endpoints were death in hospital (primary) and the recovery of COVID-19 (secondary: the time of COVID-19 nucleic acid testing turning negative). Results In the entire cohort, there were 3588 non-users, 399 ≤ 0.5 defined daily dose (DDD) PPIs users, 483 1 DDD users, and 164 ≥ 1.5 DDD users. The multivariate logistic regression analysis (odds ratio (OR) = 3.63, 95% confidence interval (CI) = 1.83-7.23, P = 0.0002) and four types of sensitivity analyses showed higher mortality in patients using PPIs during hospitalization, while the relationship between different PPIs dosages and the hospital mortality remained insignificant. Usage of the PPIs significantly prolongs the time of COVID-19 nucleic acid testing turning negative. Conclusions The use of PPIs may increase the risk of in-hospital death of patients who were laboratory-confirmed SARS-CoV-2, which means that physicians may need to re-evaluate the benefit-risk assessment of the use of PPIs during the COVID-19 pandemic.

Associations of proton pump inhibitors with susceptibility to influenza, pneumonia, and COVID-19: Evidence from a large population-based cohort study

“…For the past two decades, accumulating evidence indicates increased risks of pneumonia under the use of PPIs ( Herzig et al, 2009 ; van der Sande et al, 2021 ; Meijvis et al, 2011 ; Jeon and Kim, 2022 ), whereas others failed to show such associations ( Sarkar et al, 2008 ; Redelmeier et al, 2010 ). Conflicting findings also exist for studies referring to the risk of COVID-19 infection and related outcomes among PPI users, including several meta-analyses ( Almario et al, 2020 ; Israelsen et al, 2021 ; Fan et al, 2021 ; Lee et al, 2021 ; Li et al, 2021 ; Shah et al, 2022 ; Wu et al, 2022 ; Shupp et al, 2022 ; Shafrir et al, 2022 ). Compared with existing studies, our study more comprehensively adjusts for a variety of critical covariates by utilizing the latest data from the UK Biobank.…”

Potential common mechanism of four Chinese patent medicines recommended by diagnosis and treatment protocol for COVID-19 in medical observation period

“…Others: RAAS inhibitors ( 102 , 103 ), JAK inhibitors ( 104 ), cathepsin L-selective inhibitors, and proton pump inhibitors ( 105 ).…”

Associations of proton pump inhibitors with susceptibility to influenza, pneumonia, and COVID-19: Evidence from a large population based cohort study

“…For the past two decades, accumulating evidence indicates increased risks of pneumonia under the use of PPIs [7,8,28,29], whereas others failed to show such associations [9,10]. Conflicting findings also exist for studies referring to the risk of COVID-19 infection and related outcomes among PPI users, including several meta-analyses [11][12][13][14][15][30][31][32][33]. Concerns over protopathic bias due to non-specific and overlapping symptoms between influenza/pneumonia and acid-related diseases were raised [35].…”