Proton Pump Inhibitors Versus Histamine-2 Receptor Antagonists Likely Increase Mortality in Critical Care: An Updated Meta-Analysis - 23/02/21
, Marnie Goodwin Wilson, MDCM, MSc c, Alexander Lawandi, MDCM, MSc d, Emily G. McDonald, MDCM, MSc a, bAbstract |
Background |
Upper gastrointestinal bleeding is common among the critically ill. Recently, the Proton Pump Inhibitors (PPIs) vs. Histamine-2 Receptor Blockers for Ulcer Prophylaxis Therapy in the Intensive Care Unit (PEPTIC) trial suggested PPIs might increase mortality. We performed an updated meta-analysis to further inform discussion.
Methods |
We leveraged 2 recent systematic reviews to identify randomized controlled trials directly comparing PPIs and H-2 Receptor Antagonists (H2RAs) for stress ulcer prophylaxis in critically ill patients and reporting mortality. We extracted mortality data from each study and meta-analyzed them with the PEPTIC trial using a random effects model.
Results |
Of 28,559 total patients, 14,436 (50.5%) were allocated to PPI and 14,123 to H2RAs (49.5%). Compared to H2RAs, the pooled relative risk for mortality was 1.05 (95% confidence interval 1.00-1.10) with an estimated risk difference for mortality of 9 additional deaths per 1000 patients exposed to PPI (95% confidence interval 0-18); heterogeneity was low (I2 = 0%; P = 0.826).
Conclusions |
Stress ulcer prophylaxis with PPIs likely increases mortality compared to H2RAs. Whether stress ulcer prophylaxis is beneficial in critical care remains open to further study.
Le texte complet de cet article est disponible en PDF.Keywords : Critical care, Histamine-2 receptor antagonists, Mortality, Proton pump inhibitors, Stress ulcer prophylaxis
Plan
| Funding: This research was supported [in part] by the Intramural Research Program of the NIH, Clinical Center. The findings and conclusions in this study are those of the authors and do not necessarily represent the official position of the National Institutes of Health. |
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| Conflicts of Interest: None. |
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| Authorship: All authors had access to the data and a role in writing this manuscript. |
Vol 134 - N° 3
P. e184-e188 - mars 2021 Retour au numéro
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