Proton pump inhibitors versus histamine-2 receptor blockers for stress ulcer prophylaxis in patients with sepsis: a retrospective cohort study

Abstract

Objective We aimed to compare the efficacy and risks of proton pump inhibitor (PPI) versus histamine-2 receptor blocker (H2B) use for stress ulcer prophylaxis (SUP) in critically ill patients with sepsis and risk factors for gastrointestinal bleeding (GIB). Methods In this retrospective cohort study, we used the Medical Information Mart for Intensive Care III Clinical Database to identify critically ill adult patients with sepsis who had at least one risk factor for GIB and received either an H2B or PPI for ≥48 hours. Propensity score matching (PSM) was conducted to balance baseline characteristics. The primary outcome was in-hospital mortality. Results After 1:1 PSM, 1056 patients were included in the H2B and PPI groups. The PPI group had higher in-hospital mortality (23.8% vs. 17.5%), GIB (8.9% vs. 1.6%), and pneumonia (49.6% vs. 41.6%) rates than the H2B group. After adjusting for risk factors of GIB and pneumonia, PPI use was associated with a 1.28-times increased risk of in-hospital mortality, 5.89-times increased risk of GIB, and 1.32-times increased risk of pneumonia. Conclusions Among critically ill adult patients with sepsis at risk for GIB, SUP with PPIs was associated with higher in-hospital mortality and higher risk of GIB and pneumonia than H2Bs.

Are Proton Pump Inhibitors More Effective Than Histamine-2-Receptor Antagonists for Stress Ulcer Prophylaxis in Critically Ill Patients? A Systematic Review and Meta-Analysis of Cohort Studies

“…All of the 13 cohort studies 18,19,28-38 were published in English, among which 2 31,34 were published as conference abstracts. Twelve studies 18,19,28,30-38 were retrospective studies and the other one 29 was prospective study.…”

“…Eight cohort studies 18,19,28,31,32,35,36,38 reported the adjusted effect estimates. The detailed methods of adjustment for potential confounders, covariates, and adjusted effect estimates are presented in Supplemental Table S4.…”

“…Of the 6806 potentially relevant published reports identified, 29 reports were potentially eligible after removing duplicates and screening abstracts. Following full-text screening, 13 cohort studies 18,19,[28][29][30][31][32][33][34][35][36][37][38] were ultimately included in the systematic review, representing 145 149 patients (Figure 1).…”

“…All of the 13 cohort studies 18,19,[28][29][30][31][32][33][34][35][36][37][38] were published in English, among which 2 31,34 were published as conference abstracts. Twelve studies 18,19,28,[30][31][32][33][34][35][36][37][38] were retrospective studies and the other one 29 was prospective study. Only 6 studies 18,19,31,32,35,38 were multicenter studies.…”

Efficacy and Safety of Novel Aspirin Formulations: A Randomized, Double-Blind, Placebo-Controlled Study

“…This, however, represents the basis for assessing therapeutic strategies aimed at combining gastro-protective drugs with aspirin in order to attenuate its potential damaging effect at the gastric level [11,12]. In fact, the use of protonic pump inhibitors (PPIs), as well as H 2 histamine receptor antagonists, has been proven to be effective in protecting the gastric mucosa in patients undergoing low-dose aspirin treatment; this strategy, however, is associated with an increase in sanitary cost and is drug metabolism dependent [13,14]. Moreover, the use of aspirin formulations, in which the drug is combined with compounds that increase gastric pH, is associated with impaired aspirin absorption, as its entry into the cells is influenced by changes in its solubility, which decreases at higher pH levels [15][16][17].…”