Secondary Logo

Journal Logo


S1366 Association Between Proton Pump Inhibitor Use and COVID-19 Related Hospitalization Outcomes

Wong, Danny MD1; Bazarbashi, Ahmad Najdat MD2; Hathorn, Kelly E. MD1; McCarty, Thomas R. MD1; Redd, Walker D. MD1; Zhou, Joyce C. BA3; Njie, Cheikh MD1; Lo, Wai-Kit MD, MPH1; Shen, Lin MD1; Chan, Walter W. MD, MPH1

Author Information
The American Journal of Gastroenterology: October 2020 - Volume 115 - Issue - p S689
doi: 10.14309/01.ajg.0000707512.11979.c3
  • Free


Coronavirus disease 2019 (COVID-19) can cause systemic, respiratory, and gastrointestinal manifestations, with many patients requiring mechanical ventilation and ICU-level care. Proton-pump inhibitor (PPI) use has previously been linked to increased hospital-acquired and ventilator-associated pneumonias, although a causative relationship remains debated. The effect of PPI use in COVID-19 outcomes in unknown. We aimed to evaluate the relationship between PPI exposure and clinical outcomes of hospitalized COVID-19 patients.


This was a retrospective cohort study of consecutive adults hospitalized across nine US centers with COVID-19. The primary outcome measure was the need for mechanical ventilation in patients with and without PPI exposure during their non-ICU ward stay. The secondary outcome measure was in-hospital, all-cause mortality among patients with and without any PPI exposure. PPI use was further stratified by dosage and timing of initiation. Univariate analyses were performed using student’s t-test and Fisher’s exact test, and multivariable analyses were performed using logistic regression.


A total of 389 patients were included (mean age 62.9 years, 43.7% women), with 138 (35.5%) receiving PPI, 161 (41.3%) ICU admissions, and 57 (15.0%) deaths. PPI exposure during non-ICU ward stay correlated with increased need for mechanical ventilation [aOR 2.31 (95% CI: 1.28–4.18); P = 0.0057] after controlling for potential confounders (Table 1). For our secondary analysis, PPI use was associated with higher in-hospital, all-cause mortality [aOR 2.13 (95% CI: 1.10–4.14); P = 0.027] (Table 2). When stratified by dosage, high-dose PPI use, but not low-dose use, remained an independent predictor of both outcomes (Tables 1 and 2).


PPI use among hospitalized COVID-19 patients was independently associated with greater need for mechanical ventilation and increased mortality. Further studies are needed to determine whether this indicates a causal relationship, or whether PPI use represents underlying GERD or other comorbidities with prognostic implications.

Table 1.:
Multivariable regression models for the need for mechanical ventilation among patients with and without PPI exposure during their non-ICU ward stay
Table 2.:
Multivariable regression models for in-hospital, all-cause mortality among patients with and without any PPI exposure
© 2020 by The American College of Gastroenterology