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259 Proton pump inhibitor use is not significantly associated with severe COVID-19 related outcomes after extensive covariate adjustment

Published online by Cambridge University Press:  19 April 2022

Shailja C. Shah
Affiliation:
Gastroenterology Section, VA San Diego Healthcare System, San Diego, CA, Division of Gastroenterology, University of California, San Diego, San Diego, CA
Alese E. Halvorson
Affiliation:
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN;
Brandon McBay
Affiliation:
Department of Public Health, Harvard T.H. Chan School of Public Health, Boston, MA;
Chad Dorn
Affiliation:
Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN;
Otis Wilson
Affiliation:
The Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, University of Pennsylvania Perelman School of Medicine, Philadelphia PA;
Jason Denton
Affiliation:
Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN;
Sony Tuteja
Affiliation:
The Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, University of Pennsylvania Perelman School of Medicine, Philadelphia PA;
Kyong-Mi Chang
Affiliation:
The Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, University of Pennsylvania Perelman School of Medicine, Philadelphia PA;
Kelly Cho
Affiliation:
Boston Healthcare System & Brigham and Womens Hospital, Harvard Medical School, Boston, MA;
Richard L. Hauger
Affiliation:
Department of Psychiatry, University of California San Diego, La Jolla, CA, Center of Excellence for Stress & Mental Health, VA San Diego Healthcare System, San Diego, CA;
Ayako Suzuki
Affiliation:
Division of Gastroenterology, Duke University Medical Center, Durham, NC, Gastroenterology Section, Durham VA Health Care System, Durham, NC;
Christine M. Hunt
Affiliation:
Division of Gastroenterology, Duke University Medical Center, Durham, NC, Gastroenterology Section, Durham VA Health Care System, Durham, NC;
Edward Siew
Affiliation:
Division of Nephrology & Hypertension, Vanderbilt University Medical Center, Nashville, TN, VA Tennessee Valley, Health Services Research and Development;
Michael E. Matheny
Affiliation:
Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, Division of Nephrology & Hypertension, Vanderbilt University Medical Center, Nashville, TN, VA Tennessee Valley, Health Services Research and Development;
Adriana Hung
Affiliation:
Division of Nephrology & Hypertension, Vanderbilt University Medical Center, Nashville, TN, VA Tennessee Valley, Clinical Services Research and Development;
Robert A. Greevy
Affiliation:
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, VA Tennessee Valley, Clinical Services Research and Development;
Christianne L. Roumie
Affiliation:
Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, VA Geriatrics Research Education and Clinical Center (GRECC), VA Tennessee Valley Health System, Nashville, TN
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Abstract

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OBJECTIVES/GOALS: Using the covariate-rich Veteran Health Administration data, estimate the association between Proton Pump Inhibitor (PPI) use and severe COVID-19, rigorously adjusting for confounding using propensity score (PS)-weighting. METHODS/STUDY POPULATION: We assembled a national retrospective cohort of United States veterans who tested positive for SARS-CoV-2, with information on 33 covariates including comorbidity diagnoses, lab values, and medications. Current outpatient PPI use was compared to non-use (two or more fills and pills on hand at admission vs no PPI prescription fill in prior year). The primary composite outcome was mechanical ventilation use or death within 60 days; the secondary composite outcome included ICU admission. PS-weighting mimicked a 1:1 matching cohort, allowing inclusion of all patients while achieving good covariate balance. The weighted cohort was analyzed using logistic regression. RESULTS/ANTICIPATED RESULTS: Our analytic cohort included 97,674 veterans with SARS-CoV-2 testing, of whom 14,958 (15.3%) tested positive (6,262 [41.9%] current PPI-users, 8,696 [58.1%] non-users). After weighting, all covariates were well-balanced with standardized mean differences less than a threshold of 0.1. Prior to PS-weighting (no covariate adjustment), we observed higher odds of the primary (9.3% vs 7.5%; OR 1.27, 95% CI 1.13-1.43) and secondary (25.8% vs 21.4%; OR 1.27, 95% CI 1.18-1.37) outcomes among PPI users vs non-users. After PS-weighting, PPI use vs non-use was not associated with the primary (8.2% vs 8.0%; OR 1.03, 95% CI 0.91-1.16) or secondary (23.4% vs 22.9%;OR 1.03, 95% CI 0.95-1.12) outcomes. DISCUSSION/SIGNIFICANCE: The associations between PPI use and severe COVID-19 outcomes that have been previously reported may be due to limitations in the covariates available for adjustment. With respect to COVID-19, our robust PS-weighted analysis provides patients and providers with further evidence for PPI safety.

Type
Valued Approaches
Creative Commons
Creative Common License - CCCreative Common License - BYCreative Common License - NCCreative Common License - ND
This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.
Copyright
© The Author(s), 2022. The Association for Clinical and Translational Science