High vs Low Dose Proton Pump Inhibitor (PPI) related Mortality in Hospitalized Coronavirus Disease-19 (COVID-19): A Retrospective Cohort Study

Abstract

Introduction: The role of proton pump inhibitor (PPI) in Coronavirus Disease-19 (COVID-19) is still debatable. PPI is commonly used to prevent or treat upper gastrointestinal bleeding and/or dyspeptic symptoms. However, previous studies showed that PPI may lead to adverse outcomes in COVID-19 patients, thus the dose of PPI may play an important role. This study aimed to compare the risk of mortality between high vs low dose PPI in hospitalized COVID-19 patients.

Methods: We performed retrospective cohort study from two COVID-19 referral centers in Jakarta between June 2021 and September 2021. We included hospitalized COVID-19 patients, moderate-critically ill cases, who had been given intravenous PPI for more than 7 days. We defined high dose PPI for omeprazole greater than 40 mg/day or pantoprazole greater than 40 mg/day, and low dose PPI for omeprazole ≤40 mg/day or pantoprazole ≤40 mg/day.

Results: Of the total 365 patients (median age[Q1–Q3] 55 [45–64] years old), 216 subjects were given high dose PPI. Subjects with high dose PPI had a significantly higher mortality rate than the low dose PPI according to bivariate analysis (54.2% vs 26.1%; p less than 0.001), but quite similar length of stay (median[Q1–Q3] 12.5 [9–16] vs 13 [9–18] days). After conducting a multivariate analysis to control the confounders, we found that high dose PPI still led to higher mortality (aOR 3.04; 95%CI 1.22–7.60; p=0.017).

Conclusion: High dose PPI may increase risk of mortality in hospitalized COVID-19 patients.