Introduction Identification of risk factors for acute-on-chronic liver
failure (ACLF) is of major importance, since ACLF is a fatal complication of
cirrhosis. While a number of studies have reported an association of proton pump
inhibitor (PPI) treatment with complications of cirrhosis , the impact of PPI
treatment on the risk of ACLF is unclear. Therefore, the present study aimed to
investigate if PPI treatment affects ACLF development in patients with
cirrhosis.
Methods After retrospective screening of 642 patients undergoing
first-time elective or emergency endoscopic band ligation of esophageal varices, 74
cirrhosis patients who received long-term PPI treatment following the intervention
were 1:1 propensity score matched to 74 cirrhosis patients who did not receive PPI
treatment. The included patients were followed-up for 3 years and the development
of
ACLF, mortality and upper gastrointestinal bleeding complications were recorded.
Results ACLF was significantly more frequent in the PPI group compared
to the no-PPI group (50.0% vs. 31.1%, p=0.032). ACLF-related
deaths contributed significantly to an increased three-year mortality in the PPI
group (55.4% vs. 31.1%, p=0.025). Model for End-Stage Liver
Disease (MELD) score and PPI treatment emerged as independent predictors of ACLF
from multivariable Cox regression analyses. Of note, the impact of PPI treatment on
the development of ACLF was strongest in patients with a MELD score>12.
Gastrointestinal bleeding events were not significantly reduced in the PPI
group.
Conclusions Long-term PPI treatment is a risk factor for the
development of ACLF
Lecture Session III Metabolism (incl. NAFLD)
27/01/2023, 17.50 pm – 18.35 pm, Lecture Hall
