Pre-admission proton pump inhibitors use associated with increasing secondary infection in hospitalized COVID-19 patients: A new finding from a single center experience

ABSTRACT

Introduction: Despite advances in treatment and vaccination, COVID-19 continues to have a significant toll on healthcare services. Identifying more modifiable risk factors for severe infection is of utmost importance to guide effective health care delivery. Recent studies show conflicting results regarding the association of gastric acid suppression with the risk of developing severe COVID-19 infection. Considering that acid-suppressive medications are among the most commonly consumed drugs in the United States, an understanding of the impact of these agents on COVID-19 outcomes is of significant importance and inconclusive. We aimed to investigate if pre-admission exposure to proton pump inhibitors (PPIs) is associated with worse outcomes among patients hospitalized with COVID-19. Methods: We retrospectively identified COVID-19 patients admitted to Ochsner LSU Health, Shreveport, from July 2020 to November 2020. Information on baseline demographics, comorbidities, presenting symptoms, PPI use and clinical course was abstracted. We compared outcomes for PPI users and non-users using univariate and multivariate logistic regression. Results: 1370 patients were included in this study, with 14 (22.9%) PPI users, and 1056 (77.1%) non-users. Baseline characteristics are shown in Table 1. PPI users were older (66.00 vs 61.24, p< .0001) and had a lower BMI (31.54 vs 32.39, p< .0085) compared to non-users. Both groups received similar treatment steroids, antibiotics, remdesivir, convalescent plasma, and supplemental oxygen. There was no significant difference in the length of stay between these 2 groups. On univariate analysis, PPI users were significantly associated with developing secondary infection (OR 1.45, P=0.049) and acute kidney injury (AKI) (OR 1.45, P=0.015). The rate of developing other complications like deep venous thrombosis, pulmonary embolism, stroke, encephalopathy, shock, need for renal replacement therapy was similar in both groups. After adjusting for age, gender, race, BMI, comorbidities, PPI use was not associated with worse outcomes like ICU admission, ventilation requirement, mortality, or more complications (Figure 1). Conclusion: An interesting finding in this study was that PPI users were significantly associated with developing secondary infection but not with worse clinical outcomes or mortality. We recommend continuing PPI use when clinically indicated and educating users regarding their safety.