Risk of Stroke-Associated Pneumonia With Acid-Suppressive Drugs

Ho, Sai‐Wai; Hsieh, Ming‐Ju; Yang, Shun‐Fa; Yeh, Ying‐Tung; Wang, Yu‐Hsun; Yeh, Chih‐Jung

doi:10.1097/md.0000000000001227

Cited by 23 publications

(17 citation statements)

References 35 publications

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“…The nonsignificant association between H2B and pneumonia demonstrated by our study agrees with previous studies [7, 8], which failed to find a significant association between H2B and pneumonia in acute stroke, although the power was insufficient in one study [7], and not described in the other [8]. Our study was designed with sufficient power to detect a two-fold increase in pneumonia by H2B, and the upper limit of the 95% CI of the RR was about 1.8.…”

Section: Discussionsupporting

confidence: 93%

“…The similarity in results indicates that use of PPI is indeed associated with an increased risk of pneumonia in acute stroke patients, as observed in other disease populations [10, 12, 13]. Nonetheless, such findings apparently disagree with a study using national insurance claims data in Taiwan [8] that failed to demonstrate the association between PPI and pneumonia in acute stroke patients. The negative result may be due to differences in the definition of exposure, which was at least one use of PPI use during the follow-up.…”

Section: Discussionmentioning

confidence: 59%

“…Herzig et al [7] found that acid-suppressive medications, especially PPI, were significantly associated with pneumonia. Another study found that PPI were associated with increased risk of pneumonia in chronic stroke, but not in acute stroke [8]. The remaining study [9] found similar prevalence of pneumonia between patients receiving PPI and those receiving H2B.…”

Section: Introductionmentioning

confidence: 99%

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Histamine H2-Blocker and Proton Pump Inhibitor Use and the Risk of Pneumonia in Acute Stroke: A Retrospective Analysis on Susceptible Patients

et al. 2017

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BackgroundAlthough histamine H2-blockers (H2B) and proton pump inhibitors (PPI) are used commonly to prevent gastrointestinal bleeding in acute stroke, they are implicated in the increased risk of pneumonia in other disease populations. In acute stroke, the presence of distinctive risk factors of pneumonia, including dysphagia and impaired consciousness, makes inclusive analysis vulnerable to confounding. Our aim was to assess whether acid-suppressive drugs increase pneumonia in acute stroke in a population controlled for confounding.MethodsWe analyzed acute stroke patients admitted to a tertiary care hospital. To minimize confounding, we only included subjects who could not feed orally during 14 days of hospitalization. Exposure was defined as H2B or PPI, given in days; the outcome was development of pneumonia within this period. The incidence was calculated from the total number of pneumonias divided by the sum of person-days at risk. We additionally performed multivariate Poisson regression and propensity score analyses, although the restriction largely eliminated the need for multivariate adjustment.ResultsA total of 132 pneumonias occurred in 3582 person-days. The incidence was 3.69%/person-day (95% confidence interval (CI); 3.03–4.37%/day). All subjects had dysphagia. Stroke severity and consciousness disturbances were well-balanced between the groups exposed to H2B, PPI, or none. The relative risk (RR) compared with the unexposed was 1.22 in H2B (95%CI; 0.83–1.81) and 2.07 in PPI (95% CI; 1.13–3.62). The RR of PPI compared with H2B was 1.69 (95%CI; 0.95–2.89). In multivariate regression analysis, the RRs of H2B and PPI were 1.24 (95% CI; 0.85–1.81) and 2.00 (95% CI; 1.12–3.57), respectively; in propensity score analyses they were 1.17 (95% CI; 0.89–1.54) and 2.13 (95% CI; 1.60–2.84).ConclusionsThe results of this study suggested that prophylactic acid-suppressive therapy with PPI may have to be avoided in acute stroke patients susceptible to pneumonia.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 59%

Section: Introductionmentioning

confidence: 99%

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Histamine H2-Blocker and Proton Pump Inhibitor Use and the Risk of Pneumonia in Acute Stroke: A Retrospective Analysis on Susceptible Patients

et al. 2017

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“…GERD is considered to be a risk factor for COPD exacerbations and this can further increase the mortality in this group of patients (73). The use of acid suppressing agents (histamine-2 receptor antagonists and proton pump inhibitors) which are commonly used in GERD are associated with an increased risk of stroke-associated pneumonia (SAP) (74,75). The compromised immune state and the use of corticosteroids already puts COPD patients at higher risk for pneumonia (76).…”

Section: Impact Of Stroke On Copd Outcomesmentioning

confidence: 99%

Chronic Obstructive Pulmonary Disease and Stroke

Corlăteanu

Covanţev

Mathioudakis

et al. 2018

COPD: Journal of Chronic Obstructive Pulmonary Disease

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Chronic obstructive pulmonary disease (COPD) is currently the fourth leading cause of death in the world and its incidence and prevalence is on the rise. It is evident that COPD is linked to cardiovascular disease. In the last years, several studies demonstrated that COPD may also be a risk factor for stroke, another major cause of death worldwide. Taking in consideration that COPD has multiple comorbidities it is hard to say whether COPD is an independent risk factor for stroke or it is due to confounding effect. This review is aimed to discuss current data on COPD and stroke, potential links, therapy, and prevention. Current data suggest that COPD may increase the risk of hemorrhagic stroke. The incidence of other stroke subtypes may also be increased in COPD or may be due to confounding effect. However, COPD patients who have stroke are at risk for pulmonary and extrapulmonary complications. We conclude that more studies are needed to further clarify the links between COPD and stroke. The management of COPD as well as the use of prevention therapy is essential to decrease the risk for stroke and should be at special attention in pulmonary medicine and neurology.

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“…Previous studies have reported that proton pump inhibitors (PPIs) are positively associated with the risk of community-acquired pneumonia (CAP) for various disease and age populations [3][4][5][6][7][8] , but the letter mentioned, "The author of the manuscript has not clearly described or validated the swallowing test in these dementia patients. Swallowing problems are the one of most common causes of pneumonia.…”

Section: Reply To: Proton Pump Inhibitors and Risk Of Pneumonia In Inmentioning

confidence: 99%

Reply to: Proton Pump Inhibitors and Risk of Pneumonia in Individuals with Dementia

Yang

Yeh²

2017

J American Geriatrics Society

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Risk of Stroke-Associated Pneumonia With Acid-Suppressive Drugs

Cited by 23 publications

References 35 publications

Histamine H2-Blocker and Proton Pump Inhibitor Use and the Risk of Pneumonia in Acute Stroke: A Retrospective Analysis on Susceptible Patients

Histamine H2-Blocker and Proton Pump Inhibitor Use and the Risk of Pneumonia in Acute Stroke: A Retrospective Analysis on Susceptible Patients

Chronic Obstructive Pulmonary Disease and Stroke

Reply to: Proton Pump Inhibitors and Risk of Pneumonia in Individuals with Dementia

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