Use of proton pump inhibitors is associated with increased mortality due to nosocomial pneumonia in bedridden patients receiving tube feeding

Hamai, Kosuke; Iwamoto, Hiroshi; Ohshimo, Shinichiro; Wakabayashi, Yu; Ihara, Daisuke; Fujitaka, Kazunori; Hamada, Hironobu; Ono, Katsushige; Hattori, Noboru

doi:10.1111/ggi.13450

Cited by 12 publications

(11 citation statements)

References 23 publications

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“…As HAP is often associated with peptic disease and nonsteroidal drugs are usually used to allay patients' fever, the administration of proton-pump inhibitor was common in HAP patients. In the current study, we found that the administration of proton-pump inhibitor had a negative effect on HAP patients' 30-day mortality, consistent with the literature report [16]. Whether patients received antibiotic therapy in the preceding 90 days showed a significant difference in the outcomes of the present study, suggesting its importance as a prognostic factor for 30-day mortality with HAP.…”

Section: Discussionsupporting

confidence: 91%

Elevated Blood Urea Nitrogen-to-Serum Albumin Ratio as a Factor That Negatively Affects the Mortality of Patients with Hospital-Acquired Pneumonia

Feng

Zhou

Zou

et al. 2019

Canadian Journal of Infectious Diseases and Medical Microbiolog

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This study aimed to evaluate the factors that affect 30-day mortality of patients with HAP. The data used in this study were collected from all HAP occurred in our hospital between January 2014 and December 2017. A total of 1158 cases were included. 150 (13.0%) of whom died within 30 days. This reported mortality identified by the univariate Cox regression analysis is found to have been affected by the following factors: age greater than 70 years, presence of diabetes mellitus and chronic obstructive pulmonary disease, gastric tube intubation, administration of proton-pump inhibitor, blood albumin level less than 30 g/l, elevated neutrophil-to-lymphocyte ratio, antibiotics therapy in the preceding 90 days, intensive care unit (ICU) admission, blood lymphocyte count less than 0.8 × 109/L, elevated blood urea nitrogen/albumin (BUN/ALB) level, and presence of multidrug-resistant (MDR) pathogens. In the second multivariate analysis, administration of proton-pump inhibitor, administration of antibiotics in the preceding 90 days, ICU admission, blood lymphocyte count less than 0.8 × 109/L, elevated BUN/ALB level, and presence of MDR pathogens were still associated with 30-day mortality. The area under the receiver operating characteristic curves in the BUN/ALB predicting 30-day mortality due to HAP was 0.685. A high BUN/ALB was significantly associated with a worse survival than a low BUN/ALB P<0.001. Therefore, an elevated BUN/ALB level is a risk factor for mortality on patients with HAP.

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Section: Discussionsupporting

confidence: 91%

Elevated Blood Urea Nitrogen-to-Serum Albumin Ratio as a Factor That Negatively Affects the Mortality of Patients with Hospital-Acquired Pneumonia

Feng

Zhou

Zou

et al. 2019

Canadian Journal of Infectious Diseases and Medical Microbiolog

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“…Association between PPI use and all-cause mortality is difficult to interpret due to the large variance in patients studied to date. PPI use has been associated with increased mortality in cancer patients, liver cirrhotics, and those requiring artificial nutrition [22][23][24]. However, these patient cohorts are dissimilar to the CKD population, and thus of limited use in determining true risk.…”

Section: Discussionmentioning

confidence: 99%

Proton-pump inhibitor vs. H2-receptor blocker use and overall risk of CKD progression

et al. 2021

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Background The relationship between proton-pump inhibitor (PPI) use and chronic kidney disease (CKD) progression remains controversial. Specifically, there is a lack of data evaluating renal outcomes in established CKD patients. The aim of our study is to determine the risk of progression to end-stage kidney disease (ESKD) or death amongst CKD patients on PPI, histamine-2 receptor blocker (H2B), or no anti-acid therapy. Methods Using our CKD registry, we evaluated the relationship between PPI and H2B use and outcomes amongst patients with CKD (eGFR < 60), with at least 2 PCP visits in the year prior. A Cox proportional hazards model was used to evaluate the relationship between medication groups and overall mortality, while competing risks regression models were used to determine the risk of ESKD with death as a competing risk. Results 25,455 patients met inclusion criteria and were stratified according to medication group: no antacid therapy (15,961), PPI use (8646), or H2B use (848). At 4 years, the cumulative incidence of ESKD with death as a competing risk was 2.0% (95% CI: 1.7, 2.4), 1.5% (0.8, 2.8), and 1.6%(1.4, 1.9) among PPI, H2B, and no medication respectively (P = 0.22). The cumulative incidence of death with ESKD as a competing risk was 17.6% (95% CI: 16.6, 18.6), 16.7% (13.7, 19.8), and 17.3% (16.6, 18.0) (P = 0.71). Conclusions Use of PPI in a CKD population was not associated with increased mortality or progression to ESKD when compared to H2 blocker and to no acid suppressing therapy.

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“…Two, small cohort studies on patients with liver cirrhosis and bedridden patients requiring tube feeds also showed a positive association with PPI use and increased overall mortality. 21,22 However, another larger cohort study showed decreased 90 day mortality in hip fracture patients who were started on PPIs during their hospital stay. 23 Yet another study done by Xie and colleagues showed a small excess of cause speci c mortality due to cardiovascular disease, chronic kidney, disease, and upper gastrointestinal cancer in patients taking PPIs.…”

Section: Discussionmentioning

confidence: 99%

Proton-Pump Inhibitor vs. H2-Receptor Blocker Use and Overall Risk of CKD Progression

Cholin

Ashour

Mehdi

et al. 2020

Preprint

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Background: The relationship between proton-pump inhibitor (PPI) use and chronic kidney disease (CKD) progression remains controversial. Specifically, there is a lack of data evaluating renal outcomes in established CKD patients. The aim of our study is to determine the risk of progression to end-stage kidney disease (ESKD) or death amongst CKD patients on PPI, histamine-2 receptor blocker (H2B), or no anti-acid therapy. Methods: Using our CKD registry, we evaluated the relationship between PPI and H2B use and outcomes amongst patients with CKD (eGFR <60), with at least 2 PCP visits in the year prior. A Cox proportional hazards model was used to evaluate the relationship between medication groups and overall mortality, while competing risks regression models were used to determine the risk of ESKD with death as a competing risk.Results: 25,455 patients met inclusion criteria and were stratified according to medication group: no antacid therapy (15,961), PPI use (8,646), or H2B use (848). At 4 years, the cumulative incidence of ESKD with death as a competing risk was 2.0% (95% CI: 1.7, 2.4), 1.5% (0.8, 2.8), and 1.6%(1.4, 1.9) among PPI, H2B, and no medication respectively (P=0.22). The cumulative incidence of death with ESKD as a competing risk was 17.6% (95% CI: 16.6, 18.6), 16.7% (13.7, 19.8), and 17.3% (16.6, 18.0) (P=0.71).Conclusions: Use of PPI in a CKD population was not associated with increased mortality or progression to ESKD when compared to H2 blocker and to no acid suppressing therapy.

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Use of proton pump inhibitors is associated with increased mortality due to nosocomial pneumonia in bedridden patients receiving tube feeding

Abstract: The use of PPI in bedridden tube-fed patients was independently associated with mortality due to nosocomial pneumonia, and the PPI group had a non-significant lower incidence of gastrointestinal bleeding than the non-PPI group. Geriatr Gerontol Int 2018; 18: 1215-1218.

Cited by 12 publications

References 23 publications

Elevated Blood Urea Nitrogen-to-Serum Albumin Ratio as a Factor That Negatively Affects the Mortality of Patients with Hospital-Acquired Pneumonia

Elevated Blood Urea Nitrogen-to-Serum Albumin Ratio as a Factor That Negatively Affects the Mortality of Patients with Hospital-Acquired Pneumonia

Proton-pump inhibitor vs. H2-receptor blocker use and overall risk of CKD progression

Proton-Pump Inhibitor vs. H2-Receptor Blocker Use and Overall Risk of CKD Progression

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