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. 2014 Apr 7;14(4):e16258.
doi: 10.5812/hepatmon.16258. eCollection 2014 Apr.

Association of Proton Pump Inhibitor Therapy with Hepatic Encephalopathy in Hepatitis B Virus-related Acute-on-Chronic Liver Failure

Zhao-Ni Lin  1 , Yong-Qing Zuo  1 , Peng Hu  1
Affiliations

Association of Proton Pump Inhibitor Therapy with Hepatic Encephalopathy in Hepatitis B Virus-related Acute-on-Chronic Liver Failure

Zhao-Ni Lin et al. Hepat Mon. .

Abstract

Background: Hepatic encephalopathy (HE) is an important neuropsychiatry complication of acute-on-chronic liver failure (ACLF). PPI therapy may increase the intestinal bacterial overgrowth and infections.

Objectives: The aim of this study was to assess whether PPI use in ACLF is associated with HE.

Patients and methods: A retrospective case-control study was performed. Fifty five admitted patients with hepatitis B virus (HBV)-related ACLF complicated by Stage II-IV HE developed after admission between January 2008 and December 2012 were matched (by sex, age, and MELD score) with comparable HBV-related ACLF patients (n = 110) who did not develop this complication during hospitalization. We excluded combined HE upon admission and other neurological disorders in patients with ACLF. Univariate and multivariate analyses of 30 variables (laboratory examination, predisposition, treatment, etc.) before the occurrence of HE were carried out to identify the factors predictive of HE.

Results: In univariate analysis, patients with HE in ACLF had a significantly higher rate of PPI use (89.1%) compared with non-HE (63.6%, P = 0.001). In addition, clinical and standard laboratory variables were significantly different between the two groups regarding the infection rate, hyponatremia, alpha-fetoprotein (AFP), Arginine Hydrochloride use and Lactulose use. Logistic regression analysis was used to examine the combined effects of the variables with HE as the outcome. HE in ACLF was associated with hyponatremia (odds ratio (OR) = 6. 318, 95% confidence interval (CI) = 2. 803-14.241; P = 0. 000), PPI use was independently associated with HE (OR = 4. 392, CI = 1. 604-12.031; P = 0. 004), and lactulose use was protective (OR = 0. 294, CI = 0. 136-0.675; P = 0. 003).

Conclusions: The occurrence of HE is associated with hyponatremia and PPI use in patients with ACLF.

Keywords: Hepatic Encephalopathy; Hepatitis B Virus; Proton Pump Inhibitors.

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Figures

Figure 1.
Figure 1.. Flow Diagram of the Study Disposition
Figure 2.
Figure 2.. Kaplan–Meier Survival of the Two Groups of Patients With and Without Indication of PPI Use Who Were Followed for 90 Days
See this image and copyright information in PMC

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