Reduced survival in patients with proton pump inhibitor treatment following implantation of a transjugular intrahepatic portosystemic shunt

Introduction Several studies have pointed to negative prognostic effects of proton pump inhibitor (PPI) treatment in patients with liver cirrhosis in recent years. Until now, the relevance of a medication with PPIs in the context of implantation of a transjugular intrahepatic portosystemic shunt (TIPS) is unclear. Therefore, the aim of the present study was to investigate the prognostic impact of PPI treatment in TIPS patients.

Methods Transplant-free survival and PPI medication were reviewed in 573 cirrhotic patients allocated to TIPS implantation due to refractory ascites or variceal bleeding. Prognostic effects of PPI treatment were assessed using the Kaplan Meier method and Cox regression models (forward variable selection, likelihood-ratio method).

Results 410 patients (71.6 %) received PPI treatment. Notably, in a majority of 54.1 % thereof there was no evident indication for the medication. Transplant-free survival following TIPS implantation was significantly reduced in patients with PPI treatment with 27.0 [19.6 - 34.4] months compared to 47.0 [24.7 - 69.3] months in patients without PPI treatment (p = 0.017). Importantly, there was no significant difference between patients with and without PPI treatment with regard to stage of liver disease assessed by the Child-Pugh score (p = 0.709) and the Freiburg index of post-TIPS survival (FIPS, p = 0.612). Regression analyses also demonstrated that PPI treatment was an independent prognostic factor (HR 1.69, 95 % CI 1.20 - 2.37, p = 0.003), besides serum creatinine (HR 1.26, 95 % CI 1.13 - 1.40), p < 0.001), age (HR 1.02, 95 % CI 1.01 - 1.04, p = 0.004), covered vs. non-covered stent (HR 0.65, 95 % CI 0.50 - 0.85, p = 0.002) and viral liver disease (HR 0.64, 95 % CI 0.45 - 0.93, p = 0.020). Of note, the negative prognostic effect of PPI treatment increased with daily PPI dose (HR 1.23, 95 % CI 1.08 - 1.41, p = 0.002).

Conclusions The present study suggests that PPI treatment may have a negative prognostic impact in patients with TIPS implantation, independent of the stage of liver disease and demographic factors. Thus, the indication for PPI therapy should be checked carefully in these patients.

Publication History

Article published online:
07 September 2021