Increased mortality in Black patients with COVID-19 using PPIs
Click Here to Manage Email Alerts
Higher salivary angiotensin-converting enzyme 2 expression was observed in COVID-19-negative proton pump inhibitor users, according to a study published in The American Journal of Gastroenterology.
“[We] found significantly higher [angiotensin-converting enzyme 2 (ACE2)] messenger RNA expression levels in upper [gastrointestinal] tract of PPI users, which may predispose them to SARS-CoV-2 infection,” Julia J. Liu, MD, MSc, and colleagues wrote. “The association of the higher ACE2 expression in PPI users with respect to outcomes was assessed in our retrospective cohort of hospitalized patients with COVID-19, which included our prospective research participants: PPI usage at admission was associated with increased mortality. This mortality risk was particularly profound in Black patients with adjusted OR of 4.16, a finding that has not been previously reported. In fact, the majority (59%) of COVID-19 deaths in [African Americans] were in PPI users. Notably, most patients with COVID-19 (87%) were taking PPIs for discretionary indications, such as nonerosive [gastroesophageal reflux disease (GERD)] and/or NSAID ulcer prophylaxis. The increased ACE2 expression of the GI tract of COVID-negative patients on PPI provides a potential mechanistic basis for the increased SARS-CoV-2 infection and worse outcomes observed in PPI users during the pandemic reported in previous studies.”
Liu, from the division of gastroenterology and hepatology at University of Arkansas for Medical Sciences, and colleagues conducted a prospective study of 694 hospitalized patients with COVID-19 and controls without COVID-19 to better understand how use of PPIs may impact ACE2 expression and stool SARS-CoV-2 RNA. A retrospective cohort of hospitalized patients with COVID-19 were assessed between March 15 and Aug. 15, 2020 at six hospitals to assess correlation between PPI use and mortality. Predictors of in-hospitality mortality were determined with covariates with clinical relevance to COVID-19.
Results showed salivary ACE2 mRNA levels were higher in control PPI users compared with nonusers (2.39 vs. 1.22; P = 0.02). The PPI users and nonusers had similar salivary ACE2 levels and stool SARS-CoV-2 RNA detection rates.
“In 694 hospitalized patients with COVID-19 (age = 58 years, 46% men, and 65% Black), mortality rate in PPI users and nonusers was 30% (68/227) vs. 12.1% (53/439), respectively,” Liu and colleagues wrote.”
According to researchers, PPI use (adjusted OR = 2.72, P < .001), age (aOR = 1.66 per decade, P < .001), race (aOR = 3.03, P = .002), cancer (aOR = 2.22, P = .008), and diabetes (aOR = 1.95, P = .003) were predictors of mortality by logistic regression. Liu and colleagues noted Black patients had a higher PPI-correlated mortality risk (aOR = 4.16, 95% CI: 2.28-–7.59) compared with others (aOR = 1.62, 95% CI: 0.82-3.19, P = .04 for interaction).
Collapse
Read more about
Click Here to Manage Email Alerts