Pre-hospitalization proton pump inhibitor use and clinical outcomes in COVID-19

  1. Preethi Ramachandran
  2. Abhilash Perisetti
  3. Mahesh Gajendran
  4. Farla Jean-Louis
  5. Pardeep Bansal
  6. Alok Kumar Dwivedi
  7. Hemant Goyal

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Abstract

Severe acute respiratory syndrome coronavirus-2 may escape the inactivation by gastric acid because of hypochlorhydria caused by proton pump inhibitors (PPIs), which could predispose the patients to severe COVID-19.

Methods

We studied the association between prehospitalization PPI exposure and clinical outcomes among hospitalized COVID-19 patients.

Results

A total of 295 hospitalized COVID-19 patients were included in the study. 15.6% of hospitalized COVID-19 patients were on PPIs at home. Mortality among PPI-users was 2.3 times higher than non-users, along with 2.3 times higher risk of acute respiratory distress syndrome after adjusting for confounding variables.

Conclusion

We found that prehospitalization PPI-exposure is independently associated with worse clinical outcomes, including mortality in COVID-19 patients, regardless of the presence of cardiovascular comorbidities.

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  1. Version published to 10.1097/meg.0000000000002013
  2. ScreenIT

    SciScore for 10.1101/2020.07.12.20151084: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study was approved by the Institutional Review Board (Protocol 20-12) of Brookdale University.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    26 (SPSS Inc, Armonk, NY) and STATA 15.1 (StataCorp LLC, College Station, TX)
    SPSS
    suggested: (SPSS, RRID:SCR_002865)
    STATA
    suggested: (Stata, RRID:SCR_012763)
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Important limitations exist for this study. Our study is a single-center, retrospective, small-sized study which could introduce bias and limit its generalizability. Given the retrospective nature of the study, we could only include the information which was available in the medical records. We were unable to determine the information about the type, dose, duration, frequency, and compliance for the PPI use since we did not have access to the outpatient medical records. Lastly, potential unrecognized confounders could have been missed in our study. Despite these limitations, the main strength of the study is that it addresses a clinically significant issue about the implication of pre-hospitalization PPI use and COVID-19. In conclusion, Pre-hospitalization PPI use is prevalent in COVID-19 infected patients and associated with increased mortality and MV support among hospitalized COVID-19 patients. The results of our study warrant further investigation to evaluate if PPI-induced acid suppression is associated with worse clinical outcomes primarily because of the omnipresence of ACE-2 in the GI tract.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.07.12.20151084v1 on medRxiv