Prehospitalization Proton Pump Inhibitor (PPI) use and Clinical Outcomes in COVID-19

Abstract

AbstractBackground and AimGastric acid has shown to neutralize many viruses. The working receptor of SARS-CoV-2 is angiotensin-converting enzyme-2 (ACE-2), which has shown to be omnipresent in the gastrointestinal tract. There is a theoretical concern that SARS-CoV-2 can escape the neutralization by gastric acid because of hypochlorhydria caused by the use of proton pump inhibitors (PPI) and can predispose the patients for severe COVID-19.MethodsWe studied the association between prehospitalization PPI use and clinical outcomes among hospitalized COVID-19 patients.ResultsIn our 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 2.5 times higher risk of mechanical ventilation. This relationship existed even after adjusting for confounding variables.ConclusionThese results warrant further investigation in prospective studies to evaluate if PPI-induced hypochlorhydria is associated with worse outcomes, including mortality because of the omnipresence of ACE-2 in the gastrointestinal tract.