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

Abstract

Background and Aim Gastric 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. Methods We studied the association between prehospitalization PPI use and clinical outcomes among hospitalized COVID-19 patients. Results In 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. Conclusion These 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.