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How High PPI Doses Impact Bacterial Peritonitis Outcomes

April 29, 2018

Patients with liver cirrhosis who developed spontaneous bacterial peritonitis had worse outcomes if they were taking high doses of proton pump inhibitors (PPI), according to a study in published online in the journal Liver International (doi: 10.1111/liv.13862).

“Thus, indication for high dosage PPI therapy should be evaluated carefully in these patients,” researchers warned.

A severe complication of liver cirrhosis, spontaneous bacterial peritonitis can lead to acute kidney injury, hepatic encephalopathy, and death. Researchers conducted their study to assess the impact of PPIs on the clinical course of spontaneous bacterial peritonitis. To do so, they followed 613 consecutive patients with decompensated liver cirrhosis for the development of spontaneous bacterial peritonitis, noting whether they took PPIs and, if they did, the daily dosage.

Although the incidence of spontaneous bacterial peritonitis did not differ between the group of patients who took PPIs and the group that did not—nor between patients taking high doses of PPIs (more than 40 mg daily) and those taking lower doses, taking PPIs did affect the clinical course of spontaneous bacterial peritonitis in patients who developed the complication, the study found.

Specifically, patients taking PPIs had higher odds of acute kidney injury (71%, compared with a 43% likelihood for patients who did not take PPIs), severe hepatic encephalopathy (15% vs. 0%), and death (24% vs. 0%) in the month following spontaneous bacterial peritonitis diagnosis, researchers reported. Patients taking high doses of PPIs, in particular, had increased short term‐risk for acute kidney injury and death.

In patients without spontaneous bacterial peritonitis, however, PPI intake had no effect on acute kidney injury, hepatic encephalopathy, or death, regardless of the dosage.

Jolynn Tumolo

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