{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T10:42:08Z","timestamp":1790073728168,"version":"4.0.1"},"reference-count":40,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2018,12,18]],"date-time":"2018-12-18T00:00:00Z","timestamp":1545091200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2019,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background &amp; Aims<\/jats:title><jats:p>Many patients with cirrhosis use proton pump inhibitors. We aimed to determine their effects on the risk and prognosis of infections in patients with cirrhosis and ascites.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used data from three 1\u2010year trials of satavaptan treatment of ascites (N\u00a0=\u00a01198) to compare incidence and 90\u2010day mortality of first\u2010time infections between users and nonusers of proton pump inhibitors. With standard and marginal structural Cox models, we adjusted for differences in gender, age, cirrhosis aetiology, Model for End\u2010stage Liver Disease score, serum albumin, lactulose use, severity of ascites, and history of spontaneous bacterial peritonitis or variceal bleeding.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During the follow\u2010up, 446 patients had an infection. At inclusion, 524 patients (44%) used proton pump inhibitors, and 645 (54%) used them at some point during the follow\u2010up. Proton pump inhibitor use increased the rate of infections overall (adjusted hazard ratio\u00a0=\u00a01.43, 95% CI 1.18\u20101.74), and it also increased the rate of all specific types of infections except upper respiratory tract infections of presumably viral origin. The estimated cumulative risk of infections was 36.4% for proton pump inhibitor users vs 25.1% for nonusers at 6\u00a0months (relative risk\u00a0=\u00a01.45, 95% CI 1.22\u20101.73), and 45.2% vs 37.7% at 1\u00a0year (relative risk\u00a0=\u00a01.20, 95% 0.97\u20101.40). Use of proton pump inhibitors did not affect mortality during the 90\u00a0days following infection (adjusted hazard ratio\u00a0=\u00a00.83, 95% CI 0.53\u20101.31).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Approximately half of patients with cirrhosis and ascites use proton pump inhibitors. This use increases their risk of bacterial infections, but does not affect their prognosis after an infection occurs.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.14012","type":"journal-article","created":{"date-parts":[[2018,11,25]],"date-time":"2018-11-25T14:34:35Z","timestamp":1543156475000},"page":"514-521","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Effect of proton pump inhibitors on the risk and prognosis of infections in patients with cirrhosis and ascites"],"prefix":"10.1111","volume":"39","author":[{"given":"Gitte","family":"Dam","sequence":"first","affiliation":[{"name":"Department of Hepatology and Gastroenterology Aarhus University Hospital  Aarhus Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hendrik","family":"Vilstrup","sequence":"additional","affiliation":[{"name":"Department of Hepatology and Gastroenterology Aarhus University Hospital  Aarhus Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per Kragh","family":"Andersen","sequence":"additional","affiliation":[{"name":"Section of Biostatistics University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4641-4500","authenticated-orcid":false,"given":"Lars","family":"Bossen","sequence":"additional","affiliation":[{"name":"Department of Hepatology and Gastroenterology Aarhus University Hospital  Aarhus Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugh","family":"Watson","sequence":"additional","affiliation":[{"name":"Evotec ID  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6641-1430","authenticated-orcid":false,"given":"Peter","family":"Jepsen","sequence":"additional","affiliation":[{"name":"Department of Hepatology and Gastroenterology Aarhus University Hospital  Aarhus Denmark"},{"name":"Department of Clinical Epidemiology Aarhus University Hospital  Aarhus Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,12,18]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2010.06.019"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-016-0136-8"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0168618"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2012.179"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2012.108"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2010.89"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41395-018-0085-9"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-017-00796-x"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2011.11.019"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2009.80"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.12045"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgh.12065"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2016.04.016"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.12875"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.28737"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-007-9899-9"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2014.11.036"},{"key":"e_1_2_9_19_1","first-page":"Cr468","article-title":"Use and overuse of proton pump inhibitors in cirrhotic patients","volume":"14","author":"Chavez\u2010Tapia NC","year":"2008","journal-title":"Med Sci Monit"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.13061"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30840-7"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0110503"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgh.12426"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.12210"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2015.12.009"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2011-300157"},{"key":"e_1_2_9_27_1","unstructured":"United Network for Organ Sharing.Clerical changes for implementation of adding serum sodium to the MELD score.https:\/\/optn.transplant.hrsa.gov\/media\/1575\/policynotice_20151101.pdf. 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