Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website https://www.gastrores.org

Original Article

Volume 14, Number 3, June 2021, pages 184-189

Is the Use of Proton Pump Inhibitors a Predisposing Factor for Pyogenic Liver Abscesses?

**Table 1.** Demographics of Patients With Pyogenic Liver Abscesses
Variables	Cases (N = 277)
BMI: body mass index; IV: intravenous.
Age, median (interquartile range), years	63 (52 - 73)
Gender, n (%)
Male	148 (53%)
Female	129 (47%)
Race, n (%)
White	184 (66%)
African American	36 (13%)
Asian	45 (16%)
Hispanic	8 (3%)
Others	4 (1%)
BMI, n (%)
Under weight	1 (0%)
Normal weight	99 (36%)
Over weight	97 (35%)
Obesity class 1	55 (20%)
Obesity class 2	20 (7%)
Obesity class 3	5 (2%)
Smoking, n (%)	51 (18%)
Alcohol use, n (%)	64 (23%)
IV drug use, n (%)	3 (1%)
Diabetes mellitus, n (%)	89 (32%)
Chronic kidney disease, n (%)	25 (9%)
Malignancy, n (%)	43 (16%)
Liver cirrhosis, n (%)	14 (5%)
Cerebrovascular accident, n (%)	8 (3%)
Inflammatory bowel disease, n (%)	11 (4%)
Proton pump inhibitor, n (%)	97 (35%)
Pantoprazole	59 (21%)
Esomeprazole	6 (2%)
Lansoprazole	4 (1%)
Omeprazole	28 (10%)
No proton pump inhibitor, n (%)	180 (65%)

Table 1. Demographics of Patients With Pyogenic Liver Abscesses

Variables

Cases (N = 277)

BMI: body mass index; IV: intravenous.

Age, median (interquartile range), years

63 (52 - 73)

Gender, n (%)

Male

148 (53%)

Female

129 (47%)

Race, n (%)

White

184 (66%)

African American

36 (13%)

Asian

45 (16%)

Hispanic

8 (3%)

Others

4 (1%)

BMI, n (%)

Under weight

1 (0%)

Normal weight

99 (36%)

Over weight

97 (35%)

Obesity class 1

55 (20%)

Obesity class 2

20 (7%)

Obesity class 3

5 (2%)

Smoking, n (%)

51 (18%)

Alcohol use, n (%)

64 (23%)

IV drug use, n (%)

3 (1%)

Diabetes mellitus, n (%)

89 (32%)

Chronic kidney disease, n (%)

25 (9%)

Malignancy, n (%)

43 (16%)

Liver cirrhosis, n (%)

14 (5%)

Cerebrovascular accident, n (%)

8 (3%)

Inflammatory bowel disease, n (%)

11 (4%)

Proton pump inhibitor, n (%)

97 (35%)

Pantoprazole

59 (21%)

Esomeprazole

6 (2%)

Lansoprazole

4 (1%)

Omeprazole

28 (10%)

No proton pump inhibitor, n (%)

180 (65%)

**Table 2.** Comparison of Cases and Controls
	Cases (N = 277)	Controls (N = 554)	P
IQR: interquartile range; BMI: body mass index; IV: intravenous; DM: diabetes mellitus; CKD: chronic kidney disease; CVA: cerebrovascular accident; CHF: congestive heart failure; IBD: inflammatory bowel disease; PPI: proton pump inhibitor; ICU: intensive care unit.
Age, median (IQR), years	63 (52 - 73)	63 (51 - 74)	0.733
Gender, male	148 (53%)	296 (53%)	Matched
BMI > 30	80 (29%)	154 (28%)	0.743
Race, white	184 (66%)	368 (66%)	Matched
Smoking	51 (20%)	133 (24%)	0.179
Alcohol	64 (26%)	115 (21%)	0.088
IV drug use	3 (1%)	8 (1%)	0.999
DM	89 (32%)	185 (33%)	0.715
CKD	25 (9%)	70 (13%)	0.123
Immunosuppression	7 (3%)	3 (1%)	0.019
Malignancy	43 (16%)	77 (14%)	0.414
Liver cirrhosis	14 (5%)	14 (3%)	0.057
CVA	8 (3%)	22 (4%)	0.430
CHF	18 (7%)	45 (8%)	0.404
IBD	11 (4%)	13 (3%)	0.251
PPI use	97 (35%)	103 (19%)	0.0001
Sepsis	167 (60%)	19 (3%)	0.0001
Bacteremia	85 (31%)	8 (1%)	0.0001
Mortality	7 (3%)	14 (3%)	0.999
ICU admission	34 (12%)	33 (6%)	0.002

Table 2. Comparison of Cases and Controls

Cases (N = 277)

Controls (N = 554)

IQR: interquartile range; BMI: body mass index; IV: intravenous; DM: diabetes mellitus; CKD: chronic kidney disease; CVA: cerebrovascular accident; CHF: congestive heart failure; IBD: inflammatory bowel disease; PPI: proton pump inhibitor; ICU: intensive care unit.

Age, median (IQR), years

63 (52 - 73)

63 (51 - 74)

0.733

Gender, male

148 (53%)

296 (53%)

Matched

BMI > 30

80 (29%)

154 (28%)

0.743

Race, white

184 (66%)

368 (66%)

Matched

Smoking

51 (20%)

133 (24%)

0.179

Alcohol

64 (26%)

115 (21%)

0.088

IV drug use

3 (1%)

8 (1%)

0.999

89 (32%)

185 (33%)

0.715

CKD

25 (9%)

70 (13%)

0.123

Immunosuppression

7 (3%)

3 (1%)

0.019

Malignancy

43 (16%)

77 (14%)

0.414

Liver cirrhosis

14 (5%)

14 (3%)

0.057

CVA

8 (3%)

22 (4%)

0.430

CHF

18 (7%)

45 (8%)

0.404

IBD

11 (4%)

13 (3%)

0.251

PPI use

97 (35%)

103 (19%)

0.0001

Sepsis

167 (60%)

19 (3%)

0.0001

Bacteremia

85 (31%)

8 (1%)

0.0001

Mortality

7 (3%)

14 (3%)

0.999

ICU admission

34 (12%)

33 (6%)

0.002

**Table 3.** Uni- and Multivariate Logistic Regression Model
	Univariate	Multivariate	P
OR: odds ratio; CI: confidence interval; PPI: proton pump inhibitor; IV: intravenous; DM: diabetes mellitus; CKD: chronic kidney disease; CVA: cerebrovascular accident; IBD: inflammatory bowel disease.
PPI	2.36	1.70 - 3.27	2.27	1.55 - 3.32	< 0.001
Age	1.004	0.99 - 1.01
Gender	1	0.74 - 1.33
Race	1.01	0.87 - 1.17
Smoking	0.78	0.54 - 1.12
Alcohol	1.35	0.95 - 1.92	1.46	0.98 - 2.17	0.058
IV drug abuse	0.91	0.24 - 3.49
DM	0.94	0.69 - 1.28
CKD	0.69	0.42 - 1.10
Malignancy	1.18	0.78 - 1.77
Liver cirrhosis	2.05	0.96 - 4.37	1.82	0.77 - 4.31	1.168
CVA	0.71	0.31 - 1.63
IBD	1.59	0.71 - 3.56
Immunosuppression	4.76	1.22 - 18.55	6.63	1.5 - 28.37	0.011
Bacteremia	30.21	12.36 - 63.53	28.58	13.39 - 60.96	< 0.001

Table 3. Uni- and Multivariate Logistic Regression Model

Univariate

Multivariate

Crude OR

95% CI

Adjusted OR

95% CI

OR: odds ratio; CI: confidence interval; PPI: proton pump inhibitor; IV: intravenous; DM: diabetes mellitus; CKD: chronic kidney disease; CVA: cerebrovascular accident; IBD: inflammatory bowel disease.

PPI

2.36

1.70 - 3.27

2.27

1.55 - 3.32

< 0.001

Age

1.004

0.99 - 1.01

Gender

0.74 - 1.33

Race

1.01

0.87 - 1.17

Smoking

0.78

0.54 - 1.12

Alcohol

1.35

0.95 - 1.92

1.46

0.98 - 2.17

0.058

IV drug abuse

0.91

0.24 - 3.49

0.94

0.69 - 1.28

CKD

0.69

0.42 - 1.10

Malignancy

1.18

0.78 - 1.77

Liver cirrhosis

2.05

0.96 - 4.37

1.82

0.77 - 4.31

1.168

CVA

0.71

0.31 - 1.63

IBD

1.59

0.71 - 3.56

Immunosuppression

4.76

1.22 - 18.55

6.63

1.5 - 28.37

0.011

Bacteremia

30.21

12.36 - 63.53

28.58

13.39 - 60.96

< 0.001