A Meta-analysis Of The Relationship Between The Application Of Proton Pump Inhibitors And The Risk Of Spontaneous Bacterial Peritonitis In Patients With Liver Cirrhosis

Objective:Proton pump inhibitors,as the first-line drugs for the treatment of acid-related diseases,have been highly respected by clinicians and patients since their launch,especially in patients with liver cirrhosis,which have been widely used and even reached the level of abuse.As proton pump inhibitors are more and more widely used,their potential risk factors and adverse reactions are gradually paid attention to.This study aims to study the correlation between the application of proton pump inhibitors and spontaneous bacterial peritonitis in patients with liver cirrhosis.Methods:We searched Pub Med,Cochrane Library,Embase,China How Net,Wanfang and China Biomedicine to obtain relevant research from the establishment of the database to January 2020.A random effects model was used to calculate the merged OR and 95% CI.Sensitivity analysis used a method of excluding articles one by one to observe the impact of each article on the combined effect.A funnel chart and calculated Egger test were used to evaluate publication bias.Results:A total of 22 original articles were analyzed,involving 10537 patients with liver cirrhosis.The overall meta-analysis emphasized that the use of PPI was associated with SBP risk(merged OR 1.77,95% CI 1.56–2.00,P<0.00001).Subgroup analysis according to the population in different regions shows that North America(OR=2.35,95% CI:1.64-3.36,P<0.00001),Europe(OR=2.02,95% CI:1.34-3.04,P=0.0007),Asia(OR =1.88,95% CI:1.29-2.74,P = 0.001).In these subgroups,patients with liver cirrhosis using the PPI group had a higher risk of SBP than those not using the PPI group,but no statistics in the South American subgroup Learn meaning.The results of the subgroup analysis according to the study type and method were shown in randomized controlled studies(OR=3.45,95% CI:1.93-3.11,P=0.001),case-controlled studies(OR=2.18,95% CI:1.80-2.63,P <0.00001),controlled study(OR = 1.44,95% CI:1.01-2.03,P =0.04),retrospective study(OR=1.76,95%CI:1.34-2.33,P<0.0001),prospective research study(OR=2.13,95% CI:1.46-3.10,P <0.0001)all suggest that PPI treatment in patients with liver cirrhosis will increase the risk of SBP and has statistical significance.Patients with liver cirrhosis have a higher risk of using PPI ≥ 7days than those without PPI or use time <7 days(OR = 2.17,95% CI: 1.47-3.19,P <0.0001).Conclusion:The use of proton pump inhibitors in patients with cirrhosis increases the risk of spontaneous bacterial peritonitis.