Proton pump inhibitors impact on the severity and mortality of the acute-on-chronic liver failure: Andalusian multicentric prospective study
Description
In this study, we considered all adults aged ≥18 years who were admitted with ACLF diagnosis to the seven participating hospitals from Andalucía in Spain, between august 2020 to 2023. The diagnosis of ACLF was stablish according to the European Association for the Study of the Liver (EASL) definition based on the CANONIC study and was calculated using the CLIF Consortium Organ Function score (CLIF-C-OFs) at admission and the CLIF Consortium ACLF score (CLIF-C-ACLFs) at admission, at 3 and 7 days as a prognosis score to determine the risk of 28-days mortality. Upon admission, patients were categorized as exposed or not exposed, based on chronic PPI consumption, which was defined as daily PPI intake for more than 3 months prior to the onset of ACLF. Upon admission, data on age, gender, body mass index, comorbidities and chronic PPI intake, norfloxacin, rifaximin, lactulose, statins, antiaggregation and anticoagulation usage, the comorbidity and etiology of the cirrhosis were recorded. All of them had their CLIF-C-OFs calculated to establish the diagnosis, which included serum bilirubin and creatinine levels, the necessity of renal replacement treatment, international normalized ratio, the level of encephalopathy graded by the West-Haven classification, mean arterial pressure, the use of vasopressors, oxygen saturation and the need for mechanical ventilation. Liver function was evaluated with the Child-Pugh score and MELD-Na score. To evaluate the prognosis, the CLIF-C-ACLFs score was calculated at admission, 3 and 7 days of hospitalization, adding the age and the white-cell count to the CLIF-C-OF score. Liver, kidney and hematological function parameters were collected, along with admissions to intensive care unit, new hospitalizations for ACLF and mortality rates at 28 days, 3 months and 6 months post-admissions. The principal objective was to evaluate the potential impact of chronic PPI consumption on the severity of the ACLF. Secondary objectives included assessing its association with mortality and different types of decompensations within the ACLF.
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Steps to reproduce
To collect data, we use a unified REDCap electronic data capture system to record and manage data. Additionally, two of the main investigators monitor data consistency and correctness. The database included all the study and outcome variables that have been previously described.
Institutions
- Hospital Costa del Sol