B0312 - Proton Pump Inhibitors Are Associated With a Higher Risk of Spontaneous Bacterial Peritonitis Independently of Gastrointestinal Bleeding: A Population-Based Study

Introduction: Spontaneous Bacterial Peritonitis (SBP) is a common complication among patients with cirrhosis and is associated with increased mortality. Recent studies have suggested a possible increase in the risk of SBP among patients on Proton Pump Inhibitors (PPIs). This study aims at identifying whether PPI use is independently associated with a higher risk of SBP among cirrhotic patients.

Methods: Explorys Inc is a validated multicenter database of more than 360 hospitals from 26 different healthcare systems and ~70 million patients across the United States, and was utilized for this study. A cohort of patients with a SNOMED-CT diagnosis of “cirrhosis” between 1999-2022 was identified. A subgroup of patients with “SBP” was later identified and used for the analysis. We excluded all patients with age < 18 years. Statistical Package for Social Sciences (SPSS version 25, IBM Corp) was used for statistical analysis, and for all analyses, a 2-sided p-value of < 0.05 was considered statistically significant. Multivariate analysis was performed to adjust for multiple factors including age, gender, race, type 2 diabetes mellitus, benign hypertension, hyperlipidemia, obesity, smoking history, GI bleeding (GIB), and PPI use.

Results: 69,969,210 individuals were screened in the database and 12,850 were included in the final analysis. The prevalence rate of SBP in cirrhotic patients was 18.36%. The baselines characteristics of cirrhotic patients is shown in Table 1. SBP was more common among cirrhotic patients using PPI (OR= 1.81) independently of GIB. The diagnosis of GI bleeding (OR= 1.51) and hepatic encephalopathy (OR= 4.54) offered a higher risk for SBP as well (Table 2).

Discussion: This is the largest study for the prevalence of SBP in cirrhotic patients in the United States. Cirrhotic patients using PPI were at higher risk of developing SBP independently of GIB. Results of this study are in line with those of other smaller ones done previously.