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Fan HP, Zhou Y, Chen ML, Qiu KH, Feng X, Zhou C, Zhu ML, Huang RZ, Hu TY. Effect of proton pump inhibitors versus histamine-2 receptor antagonists on acute kidney injury in septic patients at high risk for developing stress ulcers. Pharmacotherapy 2024; 44:539-548. [PMID: 38899757 DOI: 10.1002/phar.2947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/18/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND To compare the effects of proton pump inhibitor (PPI) and histamine-2 receptor antagonist (H2RA) use on the occurrence of acute kidney injury (AKI) in septic patients at high risk for developing stress ulcers. METHODS Using the Medical Information Mart for Intensive Care IV version 2.2 database, septic patients with high-risk factors for stress ulcers (i.e., shock, coagulopathy, invasive mechanical ventilation, or chronic liver diseases) were included. Exposures included PPIs and H2RAs within 24 h of intensive care unit (ICU) admission or prior to ICU admission. The primary end point was severe sepsis-associated AKI as defined by the Kidney Disease Improving Global Outcomes criteria stage 3 (KDIGO-3). Propensity score matching (PSM) was performed to balance baseline characteristics. Multivariable Cox proportional hazards regression was used to estimate the effect size. RESULTS 4731 PPI users and 4903 H2RA users were included. After PSM, there were 1785 pairs exposed to PPIs and H2RAs. In the PSM cohort, the cumulative incident KDIGO-3 rate was higher in the PPI group than in the H2RA group (log-rank test, p = 0.009). Regression analyses showed that PPI exposure [adjusted hazard ratio 1.32, 95% confidence interval (CI) 1.11-1.58, p = 0.002] was associated with incident KDIGO-3 compared with H2RA use. This association remained consistent in sensitivity analyses. Additionally, the PPI group had a higher need for kidney replacement therapy compared with the H2RA group (3.6% vs. 2.1%, P = 0.012). CONCLUSIONS Among septic patients at high risk for developing stress ulcers, PPI exposure was associated with incident KDIGO-3 AKI compared with H2RA use.
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Affiliation(s)
- Hua-Ping Fan
- Department of Cardiology, 63650 Military Hospital, Xinjiang, China
| | - Yu Zhou
- Department of Cardiology, 63650 Military Hospital, Xinjiang, China
| | - Mei-Li Chen
- Department of Respirology and Gastroenterology, 63650 Military Hospital, Xinjiang, China
| | - Kun-Hua Qiu
- Department of Preventive Medicine, 63650 Military Hospital, Xinjiang, China
| | - Xue Feng
- Department of Cardiology, 63650 Military Hospital, Xinjiang, China
| | - Chao Zhou
- Department of Cardiology, 63650 Military Hospital, Xinjiang, China
| | - Min-Li Zhu
- Department of Respiratory Medicine, Special Medical Center of Strategic Support Force, Beijing, China
| | - Rong-Zhong Huang
- Precision Medicine Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tian-Yang Hu
- Precision Medicine Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Amerineni R, Sun H, Fernandes MB, Brandon Westover M, Moura L, Patorno E, Hsu J, Zafar SF. Real-World Continuous EEG Utilization and Outcomes in Hospitalized Patients With Acute Cerebrovascular Diseases. J Clin Neurophysiol 2023:00004691-990000000-00111. [PMID: 37938032 PMCID: PMC11058112 DOI: 10.1097/wnp.0000000000001043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
PURPOSE Continuous electroencephalography (cEEG) is recommended for hospitalized patients with cerebrovascular diseases and suspected seizures or unexplained neurologic decline. We sought to (1) identify areas of practice variation in cEEG utilization, (2) determine predictors of cEEG utilization, (3) evaluate whether cEEG utilization is associated with outcomes in patients with cerebrovascular diseases. METHODS This cohort study of the Premier Healthcare Database (2014-2020), included hospitalized patients age >18 years with cerebrovascular diseases (identified by ICD codes). Continuous electroencephalography was identified by International Classification of Diseases (ICD)/Current Procedural Terminology (CPT) codes. Multivariable lasso logistic regression was used to identify predictors of cEEG utilization and in-hospital mortality. Propensity score-matched analysis was performed to determine the relation between cEEG use and mortality. RESULTS 1,179,471 admissions were included; 16,777 (1.4%) underwent cEEG. Total number of cEEGs increased by 364% over 5 years (average 32%/year). On multivariable analysis, top five predictors of cEEG use included seizure diagnosis, hospitals with >500 beds, regions Northeast and South, and anesthetic use. Top predictors of mortality included use of mechanical ventilation, vasopressors, anesthetics, antiseizure medications, and age. Propensity analysis showed that cEEG was associated with lower in-hospital mortality (Average Treatment Effect -0.015 [95% confidence interval -0.028 to -0.003], Odds ratio 0.746 [95% confidence interval, 0.618-0.900]). CONCLUSIONS There has been a national increase in cEEG utilization for hospitalized patients with cerebrovascular diseases, with practice variation. cEEG utilization was associated with lower in-hospital mortality. Larger comparative studies of cEEG-guided treatments are indicated to inform best practices, guide policy changes for increased access, and create guidelines on triaging and transferring patients to centers with cEEG capability.
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Affiliation(s)
- Rajesh Amerineni
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Haoqi Sun
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - M. Brandon Westover
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Lidia Moura
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - John Hsu
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Sahar F. Zafar
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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Alabbadi S, Roach A, Chikwe J, Egorova NN. National trend in failure to rescue after cardiac surgeries. J Thorac Cardiovasc Surg 2023; 166:1157-1165.e6. [PMID: 35346488 DOI: 10.1016/j.jtcvs.2022.02.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 02/01/2022] [Accepted: 02/10/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Failure to rescue (FTR), defined as postoperative inpatient death after potentially treatable major complications, is a nationally endorsed quality of care measure, however, the effect of practice change on FTR is unknown. In this study, we aimed to define the FTR trend after cardiac surgery in the United States. METHODS In this retrospective analysis of the National Inpatient Sample database we identified adult patients who underwent cardiac surgeries in the United States between 2000 and 2018, defined incidence and trends in FTR adjusted for sex, age, diagnosis-related group, and comorbidity. Trends were analyzed using Joinpoint (Statistical Methodology and Applications Branch, Surveillance Research Program, National Cancer Institute) regression software. RESULTS The study included 6,185,032 hospitalizations for cardiac surgeries. Risk-adjusted FTR after deep venous thromboembolism/pulmonary embolism and sepsis has declined from 2000 to 2018 (annual percent change [APC] = -6.4% and -11.6%, respectively; P < .001). After pneumonia, FTR has increased significantly since 2011 (APC = 9.3%; P < .001). Since 2012, FTR due to gastrointestinal hemorrhage has increased substantially (APC = 15.9%; P < .001). The risk-adjusted FTR rate in patients 75 years of age or older significantly declined until 2011 (APC = -12.6%; P < .001) and became comparable with the FTR rate of younger patients by the end of the study. CONCLUSIONS There have been significant reductions in FTR in elderly patients and a reduction in postprocedural mortality associated with sepsis and venous thromboembolism overall after cardiac surgery. This might provide evidence supporting national targeted quality metrics and care bundles for complications such as pneumonia and gastrointestinal bleeding, which had an increasing FTR.
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Affiliation(s)
- Sundos Alabbadi
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amy Roach
- Cedars-Sinai Medical Center, Los-Angeles, Calif
| | | | - Natalia N Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
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Lucijanic M, Busic N, Stojic J, Barisic-Jaman M, Zagorec N, Lazibat K, Pasaric A, Vrkljan Vuk A, Durlen I, Mitrovic J, Luksic I, Barsic B. Proton pump inhibitors use prior to COVID-19 hospitalization is associated with higher C lostridioides difficile infection rate. Expert Opin Drug Saf 2023; 22:1265-1270. [PMID: 37417704 DOI: 10.1080/14740338.2023.2234821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/23/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND There are uncertainties regarding associations of prior proton pump inhibitor (PPI) use with susceptibility for COVID-19 and risks associated with SARS-CoV-2 infection. We aimed to evaluate the associations of prior PPI use with outcomes in hospitalized patients with COVID-19. RESEARCH DESIGN AND METHODS We have retrospectively evaluated a total of 5959 consecutively hospitalized patients with COVID-19 from a tertiary-level institution in the period 3/2020-6/2021. Associations of prior PPI use with outcomes of in-hospital mortality, mechanical ventilation, intensive care unit stay, venous thromboembolism, arterial thrombosis, major bleeding, bacteremia, and Clostridioides difficile infection (C. diff.) were evaluated in entire and case-matched cohorts. RESULTS Among 5959 evaluated patients, there were 1967 (33%) PPI users. In an entire cohort, prior PPI use was associated with higher in-hospital mortality and higher occurrence of C. diff. Association of prior PPI use with mortality diminished, whereas association with C. diff. persisted after multivariable adjustments. In a matched cohort, prior PPI use was associated only with higher risk of C. diff. but not other outcomes in line with multivariable analysis. CONCLUSIONS Although prior PPI use might not have a significant impact on clinical course and mortality of SARS-CoV-2 infection, it may predispose patients to the development of complications like higher occurrence of C. diff. and thus substantially impact the course of treatment.
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Affiliation(s)
- Marko Lucijanic
- Hematology Department, University Hospital Dubrava, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Nikolina Busic
- Department of Internal Medicine, University Hospital Dubrava, Zagreb, Croatia
| | - Josip Stojic
- Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, Zagreb, Croatia
| | - Mislav Barisic-Jaman
- Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, Zagreb, Croatia
| | - Nikola Zagorec
- Nephrology Department, University Hospital Dubrava, Zagreb, Croatia
| | - Karla Lazibat
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Antica Pasaric
- Clinical Immunology, Allergology and Rheumatology Department, University Hospital Dubrava, Zagreb, Croatia
| | | | - Ivan Durlen
- Nephrology Department, University Hospital Dubrava, Zagreb, Croatia
| | - Josko Mitrovic
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Internal Medicine, University Hospital Dubrava, Zagreb, Croatia
- Clinical Immunology, Allergology and Rheumatology Department, University Hospital Dubrava, Zagreb, Croatia
| | - Ivica Luksic
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Maxillofacial Surgery Department, University Hospital Dubrava, Zagreb, Croatia
| | - Bruno Barsic
- School of Medicine, University of Zagreb, Zagreb, Croatia
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Reynolds PM, Wells L, Powell M, MacLaren R. Associated Mortality Risk of Proton Pump Inhibitor Therapy for the Prevention of Stress Ulceration in Intensive Care Unit Patients: A Systematic Review and Meta-analysis. J Clin Gastroenterol 2023; 57:586-594. [PMID: 35648972 DOI: 10.1097/mcg.0000000000001723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/27/2022] [Indexed: 12/10/2022]
Abstract
GOALS The aim was to systematically evaluate risks and benefits of proton pump inhibitor (PPI) use for stress ulcer prophylaxis in the critically ill patient. BACKGROUND Whether PPIs increase mortality in the critically ill patient remains controversial. STUDY Systematic review and meta-analysis of randomized controlled trials (RCTs) and cohort studies with trial sequential analysis, Bayesian sensitivity analysis, and fragility index analysis. RESULTS A total of 31 studies in 78,009 critically ill adults receiving PPIs versus any comparator were included. PPI use was associated with an increased mortality risk in all studies [19.6% PPI vs. 17.5% comparator; RR: 1.10; 95% confidence interval (CI): 1.02-1.20; P =0.01], in the subgroup of RCTs (19.4% vs. 18.7%; RR: 1.05; 95% CI: 1.0-1.09, P =0.04), but not cohort studies (19.9% vs. 16.7%; RR: 1.12; 95% CI: 0.98-1.28, P =0.09). Results were maintained with a Bayesian sensitivity analysis (RR: 1.13; 95% credible interval: 1.035-1.227) and a fragility index analysis, but not sequential analysis ( P =0.16). RCTs with a higher baseline severity of illness revealed the greatest mortality risk with PPI use (32.1% PPI vs. 29.4% comparator; RR: 1.09; 95% CI: 1.04-1.14; P <0.001). PPI use reduced clinically important bleeding in RCTs (1.4% PPI vs. 2.1% comparator; RR: 0.67; 95% CI: 0.5-0.9; P =0.009) but increased bleeding in cohort studies (2.7% PPI vs. 1.2% comparator; RR: 2.05; 95% CI: 1.2-3.52; P =0.009). PPI use was not associated with a lower incidence of clinically important bleeding when compared with histamine-2 receptor antagonists (1.3% vs. 1.9%; RR: 0.59; 95% CI: 0.28-1.25, P =0.09). CONCLUSIONS This meta-analysis demonstrated an association between PPI use and an increased risk of mortality.
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Affiliation(s)
- Paul M Reynolds
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Denver, CO
| | - Lauren Wells
- PGY2 Emergency Medicine Pharmacy Resident, Froedtert and the Medical College of Wisconsin, Wauwatosa, WI
| | | | - Robert MacLaren
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Denver, CO
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Zhang Y, Li J, Chen Z, Liu L, Zhan X, Peng F, Zhou Q, Wu X, Zeng Y, Zhu L, Xie Y, Lai X, Wang Z, Wen Y, Feng X, Liang J. Proton pump inhibitor usage associates with higher risk of first episodes of pneumonia and peritonitis in peritoneal dialysis patients. Ren Fail 2022; 44:1623-1631. [PMID: 36195979 PMCID: PMC9542879 DOI: 10.1080/0886022x.2022.2129064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background A large number of studies have shown that proton pump inhibitors (PPIs) are associated with infection events. Therefore, we retrospectively evaluated the association of PPI therapy with the occurrence of first pneumonia and peritoneal dialysis(PD)-related peritonitis events in the maintenance PD patients. Methods We collected PD patients in two large hospitals from January 1, 2012 to December 31, 2016, and divided them into the PPI group and the non-PPI group. Multivariate Cox proportional hazards models were applied to evaluate the cumulative incidence and hazard ratios (HRs). Inverse probability of treatment weight (IPTW) method was used to adjust for covariate imbalance between the two groups and further confirm our findings. Results Finally, 656 PD patients were included for data analysis, and the results showed that PPI usage was associated with an increased risk of pneumonia [HR 1.71; 95% CI 1.06-2.76; p = 0.027] and peritonitis [HR 1.73; 95% CI 1.24-2.40; p = 0.001]. IPTW-adjusted HRs for the association of PPIs with pneumonia and peritonitis were 1.58 (95% CI:1.18-2.12; p = 0.002) and 2.33 (95% CI:1.91-2.85; p < 0.001), respectively. Moreover, the competitive risk model proved that under the conditions of competition for other events(including transfer to hemodialysis therapy, kidney transplant, transfer from our research center, loss to follow-up, and death), the differences in endpoints events between the two groups were still statistically significant (p = 0.009, p < 0.001, respectively). Conclusions PPIs was associated with an increased risk of first pneumonia and PD-related peritonitis events in PD patients, which reminds clinicians to be cautious when prescribing acid-suppressing drugs for PD patients.
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Affiliation(s)
- Yujing Zhang
- Department of Nephrology, The Second Affiliated Hospital Guangzhou Medical University, Guangzhou, China
| | - Jiao Li
- Department of Nephrology, The Second Affiliated Hospital Guangzhou Medical University, Guangzhou, China.,Department of Cardiology, The Second Affiliated Hospital Guangzhou Medical University, Guangzhou, China
| | - Zijun Chen
- Department of Nephrology, Affiliated Dongguan People's Hospital Southern Medical University, Guangdong, China
| | - Lingling Liu
- Department of General Medicine, The Third Affiliated Hospital Sun Yat-sen University, Guangzhou, China
| | - Xiaojiang Zhan
- Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Fenfen Peng
- Department of Nephrology, Zhujiang Hospital Southern Medical University, Guangzhou, China
| | - Qian Zhou
- Department of Medical Statistics, Clinical Trials Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xianfeng Wu
- Department of Nephrology, Affiliated Sixth People's Hospital Shanghai Jiao Tong University, Shanghai, China
| | - Yingsi Zeng
- Department of Nephrology, The Second Affiliated Hospital Guangzhou Medical University, Guangzhou, China
| | - Liya Zhu
- Department of Nephrology, The Second Affiliated Hospital Guangzhou Medical University, Guangzhou, China
| | - Yuxin Xie
- Department of Nephrology, The Second Affiliated Hospital Guangzhou Medical University, Guangzhou, China
| | - Xiaochun Lai
- Department of Nephrology, The Second Affiliated Hospital Guangzhou Medical University, Guangzhou, China
| | - Zebin Wang
- Department of Nephrology, The Second Affiliated Hospital Guangzhou Medical University, Guangzhou, China
| | - Yueqiang Wen
- Department of Nephrology, The Second Affiliated Hospital Guangzhou Medical University, Guangzhou, China
| | - Xiaoran Feng
- Department of Nephrology, Jiujiang NO.1 people's Hospital, Jiujiang, China
| | - Jianbo Liang
- Department of Nephrology, The Second Affiliated Hospital Guangzhou Medical University, Guangzhou, China
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Proton Pump Inhibitor Use and Associated Infectious Complications in the PICU: Propensity Score Matching Analysis. Pediatr Crit Care Med 2022; 23:e590-e594. [PMID: 35994620 DOI: 10.1097/pcc.0000000000003063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES We aimed to evaluate the association between proton pump inhibitor (PPI) exposure and nosocomial infection (NI) during PICU stay. DESIGN Propensity score matched analysis of a single-center retrospective cohort from January 1, 2017, to December 31, 2018. SETTING Tertiary medical and surgical PICU in France. PATIENTS Patients younger than 18 years old, admitted to the PICU with a stay greater than 48 hours. INTERVENTION Patients were retrospectively allocated into two groups and compared depending on whether they received a PPI or not. MEASUREMENTS AND MAIN RESULTS Seven-hundred fifty-four patients were included of which 231 received a PPI (31%). PPIs were mostly used for stress ulcer prophylaxis (174/231; 75%), but upper gastrointestinal bleed risk factors were rarely present (18%). In the unadjusted analyses, the rate of NI was 8% in the PPI exposed group versus 2% in the nonexposed group. After propensity score matching ( n = 184 per group), we failed to identify an association between PPI exposure and greater odds of NI (adjusted odds ratio 2.9 [95% CI, 0.9-9.3]; p = 0.082). However, these data have not excluded the possibility that there is up to nine-fold greater odds of NI. CONCLUSIONS This study highlights the prevalent use of PPIs in the PICU, and the potential association between PPIs and nine-fold greater odds of NI is not excluded.
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Hamilton LA, Darby SH, Rowe AS. A Retrospective Cohort Analysis of the Use of Enteral Nutrition Plus Pharmacologic Prophylaxis or Enteral Nutrition Alone. Hosp Pharm 2021; 56:729-736. [PMID: 34732931 DOI: 10.1177/0018578720954159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Due to the risk of development of stress ulcers in intensive care unit (ICU) patients, pharmacologic prophylaxis is often utilized. However, some literature describes the use of enteral nutrition instead as stress ulcer prophylaxis. Methods: The purpose of this study is to determine if enteral nutrition is similar to pharmacologic stress ulcer prophylaxis (SUP) with enteral nutrition for reduction of gastrointestinal (GI) bleeding, perforation, or ulceration in ICU patients. This was a retrospective, single-center cohort study that took place at an academic medical center. Adult ICU patients receiving enteral nutrition who had a risk factor for stress-related mucosal damage were included. The primary outcome was the incidence of GI bleeding, perforation, or ulcer formation. Results: Overall, 167 patients were included in the study, 147 in the pharmacologic prophylaxis plus EN group (PPEN) and 20 in the enteral therapy only (EN) group. Of 167 patients included, 22 patients (21 in the PPEN group and 1 in the EN group) developed a primary outcome of GI bleeding, perforation, or ulceration (14.3% vs 5%, P = .4781). Patients in the PPEN group had a higher incidence of pneumonia (42.2% vs 15%, P = .0194), but no difference was seen between groups when patients with pneumonia present on admission were excluded (20.6% vs 10.5%, P = .5254). Conclusion: In this small cohort of patients, enteral nutrition alone is as effective as pharmacologic therapy in addition to enteral nutrition for the reduction of stress-related GI bleeding, perforation, and ulceration.
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Affiliation(s)
- Leslie A Hamilton
- University of Tennessee Health Science Center College of Pharmacy, Knoxville, USA
| | - Sarah H Darby
- University of Tennessee Health Science Center College of Pharmacy, Knoxville, USA
| | - Anthony Shaun Rowe
- University of Tennessee Health Science Center College of Pharmacy, Knoxville, USA
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Pranata R, Huang I, Lawrensia S, Henrina J, Lim MA, Lukito AA, Kuswardhani RAT, Wibawa IDN. Proton pump inhibitor on susceptibility to COVID-19 and its severity: a systematic review and meta-analysis. Pharmacol Rep 2021; 73:1642-1649. [PMID: 33840053 PMCID: PMC8036156 DOI: 10.1007/s43440-021-00263-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/10/2021] [Accepted: 04/02/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The negative impacts of proton pump inhibitor (PPI), including the risk of pneumonia and mortality, have been reported previously. This meta-analysis aimed to address the current interest of whether the administration of PPI could increase the susceptibility and risk of poor outcome in COVID-19. METHODS We performed a systematic literature search from PubMed, Embase, EBSCOhost, and EuropePMC databases up until 3 December 2020. The main outcome was composite poor outcome which comprised of mortality and severe COVID-19. Severe COVID-19 in this study was defined as patients with COVID-19 that fulfill the criteria for severe CAP, including the need for intensive unit care or mechanical ventilation. The secondary outcome was susceptibility, based on cohort comparing COVID-19 positive and COVID-19 negative participants. RESULTS There were a total of 290,455 patients from 12 studies in this meta-analysis. PPI use was associated with increased composite poor outcome (OR 1.85 [1.13, 3.03], p = 0.014; I2 90.26%). Meta-regression analysis indicate that the association does not vary by age (OR 0.97 [0.92, 1.02], p = 0.244), male (OR 1.05 [0.99, 1.11], p = 0.091), hypertension (OR 9.98 [0.95, 1.02], p = 0.317), diabetes (OR 0.99 [0.93, 1.05], p = 0.699), chronic kidney disease (OR 1.01 [0.93, 1.10], p = 0.756), non-steroidal anti-inflammatory drug use (OR 1.02 [0.96, 1.09], p = 0.499), and pre-admission/in-hospital PPI use (OR 0.77 [0.26, 2.31], p = 0.644). PPI use was not associated with the susceptibility to COVID-19 (OR 1.56 [0.48, 5.05], p = 0.46; I2 99.7%). CONCLUSION This meta-analysis showed a potential association between PPI use and composite poor outcome, but not susceptibility. PROSPERO ID CRD42020224286.
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Affiliation(s)
- Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Ian Huang
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia.,Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | | | | | | | - Antonia Anna Lukito
- Department of Cardiology and Vascular Medicine, Siloam Hospitals Lippo Village, Tangerang, Indonesia.
| | - Raden Ayu Tuty Kuswardhani
- Department of Internal Medicine, Faculty of Medicine, Udayana University, Sanglah Teaching Hospital, Denpasar- Bali, Indonesia
| | - I Dewa Nyoman Wibawa
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Udayana, Denpasar, Indonesia
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Effects of daily treatment with acid suppressants for stress ulcer prophylaxis on risk of ventilator-associated events. Infect Control Hosp Epidemiol 2021; 41:187-193. [PMID: 31818336 DOI: 10.1017/ice.2019.323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To estimate the effects of continuous daily treatment with different acid suppressants on the risk of ventilator-associated events in critically ill patients. DESIGN Retrospective cohort study. PATIENTS Adult critically ill patients who underwent mechanical ventilation for ≥3 days during an inpatient admission between January 2006 and December 2014. METHODS We estimated the 30-day cumulative risk ratios (RRs) for ventilator-associated events comparing daily proton pump inhibitor (PPI) versus daily histamine-2-receptor antagonist (H2RA) strategies while controlling for time-fixed and time-varying confounding and accounting for competing events. RESULTS Of 6,133 patients, on ventilation day 3, 58.8% received H2RAs, 26.1% received PPIs, and 4.1% received sucralfate. Patients frequently changed treatment throughout follow-up. Among 4,595 patients receiving PPIs or H2RAs on day 3, we found no differences in risk estimates for ventilator mortality and extubation alive comparing daily PPI versus daily H2RA strategies: RR, mortality, 1.03 (95% CI, 0.89-1.22); extubation alive, 1.00 (95% CI, 0.96-1.03). We found similar results after accounting for PPI dose. For possible ventilator-associated pneumonia (PVAP) and infection-related ventilator-associated complication (IVAC), point estimates were larger, but the 95% CIs crossed 1.0: RR PVAP, 1.25 (95% CI, 0.80-1.94); IVAC, 0.89 (95% CI, 0.64-1.17). The magnitude of effect estimates depended on PPI dose. The RR for PVAP, high-dose PPI versus H2RA, was 1.53 (95% CI, 0.82-2.51), and for low-dose PPI versus H2RA, the RR was 0.97 (95% CI, 0.47-1.63). For IVAC, high-dose PPI versus H2RA, the RR was 1.01 (95% CI, 0.66-1.42), and for low-dose PPI versus H2RA, the RR was 0.78 (95% CI, 0.50-1.11). CONCLUSIONS We estimated no effect of daily PPI versus daily H2RA on risk of mortality or extubation alive in critically ill patients. Further investigation with larger samples is warranted for PVAP and IVAC.
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11
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Tranberg A, Samuelsson C, Klarin B. Disturbance in the oropharyngeal microbiota in relation to antibiotic and proton pump inhibitor medication and length of hospital stay. APMIS 2021; 129:14-22. [PMID: 32981186 PMCID: PMC7756849 DOI: 10.1111/apm.13087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 09/21/2020] [Indexed: 12/30/2022]
Abstract
The aim of this study was to investigate the appearance of a disturbed oropharyngeal microbiota during hospitalization and explore the patient characteristics that maybe associated with such a disturbance. Oropharyngeal swabs were collected from 134 patients at hospital admission and every 3-4 days thereafter. The samples were cultivated to determine the presence of a disturbed microbiota, which, in turn, was subcategorized into respiratory tract pathogens, gut microbiota and yeast species. Demographics, medical history data and hospitalization events were compared. The percentage of disturbed oropharyngeal microbiota increased significantly with length of stay (LOS). Receiving antibiotic treatment during the hospitalization tended to be associated with a disturbed microbiota (OR 2.75 [0.99-7.60]). Proton pump inhibitor (PPI) medication and receiving antibiotics before hospitalization were associated with the development of a disturbed oropharyngeal microbiota with colonization of gut pathogens (OR 3.49 [1.19-10.2] and OR 4.52 [1.13-18.1], respectively), while acute hospital admission was associated with a lower risk of colonization of gut pathogens (OR: 0.23 [0.074-0.72]). The risk of developing a disturbed oropharyngeal microbiota increased with LOS in hospitalized patients. PPI medication and receiving antibiotics before hospitalization were independent risk factors for developing oropharyngeal colonization of gut pathogens.
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Affiliation(s)
- Anna Tranberg
- Division of Intensive and Perioperative CareSkane University HospitalLundSweden
| | - Carolina Samuelsson
- Division of Intensive and Perioperative CareSkane University HospitalLundSweden
| | - Bengt Klarin
- Division of Intensive and Perioperative CareSkane University HospitalLundSweden
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Yao R, Liu X, He Y, Mei C, Shen Y, Zhan Q, Huang L, Li B, Li N. Low platelet count is a risk factor of postoperative pneumonia in patients with type A acute aortic dissection. J Thorac Dis 2020; 12:2333-2342. [PMID: 32642138 PMCID: PMC7330411 DOI: 10.21037/jtd.2020.03.84] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background Previous studies have already established that low platelet count is related to adverse outcomes in patients with type A acute aortic dissection (AAAD). However, there are yet limited studies investigating the association of platelet count and the risk of postoperative pneumonia in AAAD patients. Methods This retrospective cohort study was conducted in Xiangya Hospital of Central South University from January 2014 to May 2019. Clinical and laboratory data were collected. The correlation between platelet count and postoperative pneumonia was analyzed using multivariate logistic regression and the area under the receiver operating characteristic curve (AUC) was used to assess the predictive power of platelet count on pneumonia. Results A total of 268 patients with AAAD were enrolled. The overall incidence of pneumonia was 36.94% (n=99). Multivariate logistic regression revealed that platelet count was negatively associated with the risk of postoperative pneumonia (OR 0.93; 95% CI: 0.88–0.98) after adjusting for the confounders. Compared to the lowest platelet count tertile (T1), medium platelet count (T2) and highest platelet count (T3) had a lower risk of postoperative pneumonia after adjusting for the confounders (OR 0.80, 95% CI: 0.40–1.60; OR 0.30, 95% CI: 0.13–0.66; respectively). A similar trend was observed when the platelet count was handled as categorical variables (tertiles). The area under the ROC curve was 0.635 (95% CI: 0.565–0.707), with a sensitivity of 76.77%, a specificity of 50.89% and an accuracy of 60.45%. Conclusions Our findings indicate that low platelet count is an independent risk factor of postoperative pneumonia in patients with AAAD and has a specific predictive power on the risk of postoperative pneumonia.
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Affiliation(s)
- Run Yao
- Department of Blood Transfusion, Xiangya Hospital, Central South University, Changsha 410007, China
| | - Xianglin Liu
- Department of Anesthesiology, Changsha Maternal and Child Health Hospital, Changsha 410007
| | - Yi He
- Department of Blood Transfusion, Xiangya Hospital, Central South University, Changsha 410007, China
| | - Cheng Mei
- Department of Blood Transfusion, Xiangya Hospital, Central South University, Changsha 410007, China
| | - Yamei Shen
- Department of Blood Transfusion, Xiangya Hospital, Central South University, Changsha 410007, China
| | - Qinru Zhan
- Department of Blood Transfusion, Xiangya Hospital, Central South University, Changsha 410007, China
| | - Lingjin Huang
- Department of Cardiac Surgery, Xiangya Hospital, Central South University, Changsha 410007, China
| | - Bijuan Li
- Department of Blood Transfusion, Xiangya Hospital, Central South University, Changsha 410007, China
| | - Ning Li
- Department of Blood Transfusion, Xiangya Hospital, Central South University, Changsha 410007, China
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13
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Santos YDAPD, Younes-Ibrahim MS, Crozatti LL, Raglione D, Cardozo Junior LCM, Besen BAMP, Taniguchi LU, Park M, Mendes PV. Adherence to a stress ulcer prophylaxis protocol by critically ill patients: a prospective cohort study. Rev Bras Ter Intensiva 2020; 32:37-42. [PMID: 32401969 PMCID: PMC7206951 DOI: 10.5935/0103-507x.20200007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 09/03/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To evaluate adherence to the stress ulcer prophylaxis protocol in critically ill patients at a tertiary university hospital. METHODS In this prospective cohort study, we included all adult patients admitted to the medical and surgical intensive care units of an academic tertiary hospital. Our sole exclusion criterion was upper gastrointestinal bleeding at intensive care unit admission. We collected baseline variables and stress ulcer prophylaxis indications according to the institutional protocol and use of prophylaxis. Our primary outcome was adherence to the stress ulcer prophylaxis protocol. Secondary outcomes were appropriate use of stress ulcer prophylaxis, upper gastrointestinal bleeding incidence and factors associated with appropriate use of stress ulcer prophylaxis. RESULTS Two hundred thirty-four patients were enrolled from July 2nd through July 31st, 2018. Patients were 52 ± 20 years old, 125 (53%) were surgical patients, and the mean SAPS 3 was 52 ± 20. In the longitudinal follow-up, 1499 patient-days were studied; 1069 patient-days had stress ulcer prophylaxis indications, and 777 patient-days contained prophylaxis use (73% stress ulcer prophylaxis protocol adherence). Of the 430 patient-days without stress ulcer prophylaxis indications, 242 involved prophylaxis (56% inappropriate stress ulcer prophylaxis use). The overall appropriate use of stress ulcer prophylaxis was 64%. Factors associated with proper stress ulcer prophylaxis prescription were mechanical ventilation OR 2.13 (95%CI 1.64 - 2.75) and coagulopathy OR 2.77 (95%CI 1.66 - 4.60). The upper gastrointestinal bleeding incidence was 12.8%. CONCLUSION Adherence to the stress ulcer prophylaxis protocol was low and inappropriate use of stress ulcer prophylaxis was frequent in this cohort of critically ill patients.
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Affiliation(s)
| | | | | | - Dante Raglione
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | | | - Leandro Utino Taniguchi
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Marcelo Park
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Pedro Vitale Mendes
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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14
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Could stress ulcer prophylaxis increase mortality in high-acuity patients? Intensive Care Med 2020; 46:793-795. [DOI: 10.1007/s00134-020-05959-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/04/2020] [Indexed: 01/08/2023]
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15
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Young PJ, Bagshaw SM, Forbes AB, Nichol AD, Wright SE, Bailey M, Bellomo R, Beasley R, Brickell K, Eastwood GM, Gattas DJ, van Haren F, Litton E, Mackle DM, McArthur CJ, McGuinness SP, Mouncey PR, Navarra L, Opgenorth D, Pilcher D, Saxena MK, Webb SA, Wiley D, Rowan KM. Effect of Stress Ulcer Prophylaxis With Proton Pump Inhibitors vs Histamine-2 Receptor Blockers on In-Hospital Mortality Among ICU Patients Receiving Invasive Mechanical Ventilation: The PEPTIC Randomized Clinical Trial. JAMA 2020; 323:616-626. [PMID: 31950977 PMCID: PMC7029750 DOI: 10.1001/jama.2019.22190] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE Proton pump inhibitors (PPIs) or histamine-2 receptor blockers (H2RBs) are often prescribed for patients as stress ulcer prophylaxis drugs in the intensive care unit (ICU). The comparative effect of these drugs on mortality is unknown. OBJECTIVE To compare in-hospital mortality rates using PPIs vs H2RBs for stress ulcer prophylaxis. DESIGN, SETTING, AND PARTICIPANTS Cluster crossover randomized clinical trial conducted at 50 ICUs in 5 countries between August 2016 and January 2019. Patients requiring invasive mechanical ventilation within 24 hours of ICU admission were followed up for 90 days at the hospital. INTERVENTIONS Two stress ulcer prophylaxis strategies were compared (preferential use with PPIs vs preferential use with H2RBs). Each ICU used each strategy sequentially for 6 months in random order; 25 ICUs were randomized to the sequence with use of PPIs and then use of H2RBs and 25 ICUs were randomized to the sequence with use of H2RBs and then use of PPIs (13 436 patients randomized by site to PPIs and 13 392 randomized by site to H2RBs). MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality within 90 days during index hospitalization. Secondary outcomes were clinically important upper gastrointestinal bleeding, Clostridioides difficile infection, and ICU and hospital lengths of stay. RESULTS Among 26 982 patients who were randomized, 154 opted out, and 26 828 were analyzed (mean [SD] age, 58 [17.0] years; 9691 [36.1%] were women). There were 26 771 patients (99.2%) included in the mortality analysis; 2459 of 13 415 patients (18.3%) in the PPI group died at the hospital by day 90 and 2333 of 13 356 patients (17.5%) in the H2RB group died at the hospital by day 90 (risk ratio, 1.05 [95% CI, 1.00 to 1.10]; absolute risk difference, 0.93 percentage points [95% CI, -0.01 to 1.88] percentage points; P = .054). An estimated 4.1% of patients randomized by ICU site to PPIs actually received H2RBs and an estimated 20.1% of patients randomized by ICU site to H2RBs actually received PPIs. Clinically important upper gastrointestinal bleeding occurred in 1.3% of the PPI group and 1.8% of the H2RB group (risk ratio, 0.73 [95% CI, 0.57 to 0.92]; absolute risk difference, -0.51 percentage points [95% CI, -0.90 to -0.12 percentage points]; P = .009). Rates of Clostridioides difficile infection and ICU and hospital lengths of stay were not significantly different by treatment group. One adverse event (an allergic reaction) was reported in 1 patient in the PPI group. CONCLUSIONS AND RELEVANCE Among ICU patients requiring mechanical ventilation, a strategy of stress ulcer prophylaxis with use of proton pump inhibitors vs histamine-2 receptor blockers resulted in hospital mortality rates of 18.3% vs 17.5%, respectively, a difference that did not reach the significance threshold. However, study interpretation may be limited by crossover in the use of the assigned medication. TRIAL REGISTRATION anzctr.org.au Identifier: ACTRN12616000481471.
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Affiliation(s)
| | - Paul J Young
- Medical Research Institute of New Zealand, Wellington
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
| | - Sean M Bagshaw
- Department of Critical Care Medicine, University of Alberta Hospital, Edmonton, Canada
| | | | - Alistair D Nichol
- Intensive Care Unit, Alfred Hospital, Melbourne, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
- University College Dublin-Clinical Research Centre, St Vincent's Hospital, Dublin, Ireland
| | - Stephen E Wright
- Intensive Care Unit, Freeman Hospital, Newcastle upon Tyne, England
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- Intensive Care Unit, Austin Hospital, Heidelberg, Australia
| | | | - Kathy Brickell
- University College Dublin-Clinical Research Centre, St Vincent's Hospital, Dublin, Ireland
| | | | - David J Gattas
- Intensive Care Unit, Royal Prince Alfred Hospital, Camperdown, Australia
- George Institute for Global Health, University of New South Wales, Sydney, Australia
| | | | - Edward Litton
- Intensive Care Unit, Fiona Stanley Hospital, Murdoch, Australia
| | | | - Colin J McArthur
- Medical Research Institute of New Zealand, Wellington
- Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Shay P McGuinness
- Medical Research Institute of New Zealand, Wellington
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
| | - Paul R Mouncey
- Intensive Care National Audit and Research Centre, London, England
| | | | - Dawn Opgenorth
- Department of Critical Care Medicine, University of Alberta Hospital, Edmonton, Canada
| | - David Pilcher
- Intensive Care Unit, Alfred Hospital, Melbourne, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
- Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation, Camberwell, Australia
| | - Manoj K Saxena
- George Institute for Global Health, University of New South Wales, Sydney, Australia
- Intensive Care Unit, Bankstown Hospital, Bankstown, Australia
| | - Steve A Webb
- Intensive Care Unit, Royal Perth Hospital, Perth, Australia
| | - Daisy Wiley
- Intensive Care National Audit and Research Centre, London, England
| | - Kathryn M Rowan
- Intensive Care National Audit and Research Centre, London, England
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16
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Adverse outcomes of proton pump inhibitors in chronic liver disease: a systematic review and meta-analysis. Hepatol Int 2020; 14:385-398. [PMID: 31912308 DOI: 10.1007/s12072-019-10010-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/03/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIM Proton pump inhibitors (PPIs) are among the most commonly prescribed medications in the US, but their safety in cirrhosis has recently been questioned. We performed a meta-analysis of observational studies to evaluate the impact of PPIs on adverse clinical outcomes in the setting of chronic liver disease (CLD). METHODS We searched several databases from inception to 26 May 2019 to identify comparative studies evaluating the effect of PPIs in CLD. Outcomes of interest were the associations between PPIs use and the occurrence of hepatic encephalopathy, hepatocellular carcinoma, spontaneous bacterial peritonitis, bacterial infections, and mortality in CLD. We performed a meta-analysis in accordance to the PRISMA guidelines. RESULTS Of 14,662 papers evaluated, 47 studies with 169,806 participants were identified. Of these, 35 were cohort studies and 12 were case-control studies. The pooled odds ratio (OR) for hepatic encephalopathy in individuals with PPI users, compared with those without, was 2.31 (95% CI 1.63-3.28). The pooled OR for spontaneous bacterial peritonitis in individuals with PPI users was significantly higher compared with non-PPI users (OR = 1.72, 95% CI 1.42-2.09). Results were also consistent with a higher risk of the bacterial infections and mortality in PPI users compared with non-PPI users. For hepatocellular carcinoma, the final conclusion cannot be drawn because of the limited number of studies. CONCLUSIONS This study identifies a significant relationship between PPIs therapies and several specific adverse clinical outcomes in CLD. However, these results should be carefully considered given the potential selection bias and unmeasured confounding variables in observational studies, it may be reasonable to re-evaluate the need for PPIs in patients with CLD.
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17
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Abstract
Stress ulcer prophylaxis (SUP) with acid-suppressive drug therapy is widely utilized in critically ill patients following neurologic injury for the prevention of clinically important stress-related gastrointestinal bleeding (CIB). Data supporting SUP, however, largely originates from studies conducted during an era where practices were vastly different than what is considered routine by today's standard. This is particularly true in neurocritical care patients. In fact, the routine provision of SUP has been challenged due to an increasing prevalence of adverse drug events with acid-suppressive therapy and the perception that CIB rates are sparse. This narrative review will discuss current controversies with SUP as they apply to neurocritical care patients. Specifically, the pathophysiology, prevalence, and risk factors for CIB along with the comparative efficacy, safety, and cost-effectiveness of acid-suppressive therapy will be described.
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18
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Barletta JF, Buckley MS, MacLaren R. The SUP-ICU Trial: Does It Confirm or Condemn the Practice of Stress Ulcer Prophylaxis? Hosp Pharm 2019; 55:96-101. [PMID: 32214442 DOI: 10.1177/0018578719867687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Purpose: Stress ulcer prophylaxis (SUP) is routinely administered to critically ill patients for the prevention of stress ulcer-induced, clinically important bleeding (CIB). Recently, the value of SUP has been questioned due to the perceived decline in CIB and the potential for infectious complications secondary to acid suppressive therapy. The SUP-ICU trial is a large, randomized controlled trial comparing intravenous pantoprazole with placebo for the indication of SUP. It is hoped that this trial would answer many of the questions pertaining to the overall value of SUP. This article will provide an in-depth assessment of the SUP-ICU trial in the context of the overall body of literature in this area. Furthermore, applications for clinical practice and recommendations on the provision of SUP are provided. Summary: The SUP-ICU trial revealed no difference in the primary outcome of 90-day mortality with pantoprazole but lower rates of CIB were noted (which was a secondary outcome). Overall, these data provide important insight into the value of SUP along with other questions related to the provision of SUP such as the relationship between CIB and mortality, infectious complications, and enteral nutrition. Conclusions: The SUP-ICU trial is a landmark trial describing the value of SUP in a modern-day setting of intensive care unit (ICU) practice. The provision of SUP should be continued in high-risk patients. Future studies are ongoing that will add further insight to this routine practice.
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19
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Marchina S, Doros G, Modak J, Helenius J, Aycock DM, Kumar S. Acid-suppressive medications and risk of pneumonia in acute stroke patients: A systematic review and meta-analysis. J Neurol Sci 2019; 400:122-128. [DOI: 10.1016/j.jns.2019.02.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/20/2018] [Accepted: 02/28/2019] [Indexed: 01/08/2023]
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20
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Mendes JJ, Silva MJ, Miguel LS, Gonçalves MA, Oliveira MJ, Oliveira CDL, Gouveia J. Sociedade Portuguesa de Cuidados Intensivos guidelines for stress ulcer prophylaxis in the intensive care unit. Rev Bras Ter Intensiva 2019; 31:5-14. [PMID: 30843949 PMCID: PMC6443317 DOI: 10.5935/0103-507x.20190002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 09/08/2018] [Indexed: 12/18/2022] Open
Abstract
Critically ill patients are at risk of developing stress ulcers in the upper
digestive tract. Agents that suppress gastric acid are commonly prescribed to
reduce the incidence of clinically important stress ulcer-related
gastrointestinal bleeding. However, the indiscriminate use of stress ulcer
prophylaxis in all patients admitted to the intensive care unit is not warranted
and can have potential adverse clinical effects and cost implications. The
present guidelines from the Sociedade Portuguesa de Cuidados
Intensivos summarizes the current evidence and gives six clinical
statements and an algorithm aiming to provide a standardized prescribing policy
for the use of stress ulcer prophylaxis in the intensive care unit.
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Affiliation(s)
| | - Mário Jorge Silva
- Departamento de Gastrenterologia, Centro Hospitalar de Lisboa Central E.P.E. - Lisboa, Portugal
| | - Luís Silva Miguel
- Centro de Medicina Baseada em Evidência, Faculdade de Medicina, Universidade de Lisboa - Lisboa, Portugal
| | | | - Maria João Oliveira
- Departamento de Farmácia, Hospital Prof. Doutor Fernando da Fonseca E.P.E. - Amadora, Portugal
| | | | - João Gouveia
- Sociedade Portuguesa de Cuidados Intensivos - Lisboa, Portugal
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21
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Jaynes M, Kumar AB. The risks of long-term use of proton pump inhibitors: a critical review. Ther Adv Drug Saf 2018; 10:2042098618809927. [PMID: 31019676 PMCID: PMC6463334 DOI: 10.1177/2042098618809927] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 09/28/2018] [Indexed: 12/17/2022] Open
Abstract
Proton pump inhibitors (PPIs) are among the most frequently prescribed
medications. Their use is likely even higher than estimated due to an increase
in the number of PPIs available without a prescription. Appropriate indications
for PPI use include Helicobacter pylori infection, erosive
esophagitis, gastric ulcers, and stress ulcer prevention in high-risk critically
ill patients. Unfortunately, PPIs are often used off-label for extended periods
of time. This increase in PPI usage over the past two decades has called into
question the long-term effects of these medications. The association between PPI
use and infection, particularly Clostridium difficile and
pneumonia, has been the subject of several studies. It’s proposed that
the alteration in gastrointestinal microflora by PPIs produces an environment
conducive to development of these types of infections. At least one study has
suggested that long-term PPI use increases the risk of dementia. Drug
interactions are an important and often overlooked consideration when
prescribing any medication. The potential interaction between PPIs and
antiplatelet agents has been the subject of multiple studies. One of the more
recent concerns with PPI use is their role in the development or progression of
chronic kidney disease. There is also some literature suggesting that PPIs
contribute to the development of various micronutrient deficiencies. Most of the
literature examining the potential adverse effects of PPI use is composed of
retrospective, observation studies. There is a need for higher quality studies
exploring this relationship.
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Affiliation(s)
- Megan Jaynes
- Division of Critical Care, Department of Pharmacy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Avinash B Kumar
- Division of Critical Care, Department of Anesthesiology, Vanderbilt University, Nashville, TN 37212, USA
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22
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Tranberg A, Thorarinsdottir HR, Holmberg A, Schött U, Klarin B. Proton pump inhibitor medication is associated with colonisation of gut flora in the oropharynx. Acta Anaesthesiol Scand 2018. [PMID: 29520757 DOI: 10.1111/aas.13094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The normal body exists in mutualistic balance with a large range of microbiota. The primary goal of this study was to establish whether there is an imbalance in the oropharyngeal flora early after hospital or ICU admittance, and whether flora differs between control, ward and critically ill patients. The secondary goal was to explore whether there are patient characteristics that can be associated with a disturbed oropharyngeal flora. METHODS Oropharyngeal cultures were obtained from three different study groups: (1) controls from the community, (2) ward patients and (3) critically ill patients, the two latter within 24 h after admittance. RESULTS Cultures were obtained from 487 individuals: 77 controls, 193 ward patients and 217 critically ill patients. Abnormal pharyngeal flora was more frequent in critically ill and ward patients compared with controls (62.2% and 10.4% vs. 1.3%, P < 0.001 and P = 0.010, respectively). Colonisation of gut flora in the oropharynx was more frequent in critically ill patients compared with ward patients or controls (26.3% vs. 4.7% and 1.3%, P < 0.001 and P < 0.001, respectively). Proton pump inhibitor medication was the strongest independent factor associated with the presence of gut flora in the oropharynx in both ward and critically ill patients (P = 0.030 and P = 0.044, respectively). CONCLUSION This study indicates that abnormal oropharyngeal flora is an early and frequent event in hospitalised patients and more so in the critically ill, compared to controls. Proton pump inhibitor medication is associated with colonisation of gut flora in the oropharynx.
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Affiliation(s)
- A. Tranberg
- Division of Intensive and Perioperative Care; Skåne University Hospital; Lund Sweden
| | - H. R. Thorarinsdottir
- Division of Intensive and Perioperative Care; Skåne University Hospital; Lund Sweden
| | - A. Holmberg
- Division of Infection Medicine; Department of Clinical Sciences; Lund University; Lund Sweden
| | - U. Schött
- Division of Intensive and Perioperative Care; Skåne University Hospital; Lund Sweden
| | - B. Klarin
- Division of Intensive and Perioperative Care; Skåne University Hospital; Lund Sweden
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Affiliation(s)
- Deborah Cook
- From the Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Gordon Guyatt
- From the Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
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Hamai K, Iwamoto H, Ohshimo S, Wakabayashi Y, Ihara D, Fujitaka K, Hamada H, Ono K, Hattori N. Use of proton pump inhibitors is associated with increased mortality due to nosocomial pneumonia in bedridden patients receiving tube feeding. Geriatr Gerontol Int 2018; 18:1215-1218. [PMID: 29785745 DOI: 10.1111/ggi.13450] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 04/18/2018] [Accepted: 04/25/2018] [Indexed: 01/27/2023]
Abstract
AIM To investigate the association between the use of proton pump inhibitors (PPI) and nosocomial pneumonia and gastrointestinal bleeding in bedridden patients receiving tube feeding. METHODS A total of 116 bedridden hospitalized patients receiving tube feeding, of which 80 were supported by percutaneous endoscopic gastrostomy and 36 by nasogastric tube, were included in the present study. The patients were divided into two groups: 62 patients treated with PPI (PPI group) and 54 patients without PPI (non-PPI group). Mortality due to nosocomial pneumonia was evaluated using the Kaplan-Meier approach and the log-rank test. RESULTS A total of 36 patients (31%) died of nosocomial pneumonia during the observation period; the mortality rate due to nosocomial pneumonia was significantly higher in the PPI group than in the non-PPI group (P = 0.0395). Cox proportional hazard analysis showed that the use of PPI and lower levels of serum albumin were independent predictors of 2-year mortality due to nosocomial pneumonia. Gastrointestinal bleeding was observed in four patients in the non-PPI group (7.7%) and in one patient in the PPI group (1.6%); there was no significant difference between the two groups. CONCLUSION 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.
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Affiliation(s)
- Kosuke Hamai
- Department of Respiratory Medicine, Hiroshima Prefectural Hospital, Hiroshima, Japan.,Department of Internal Medicine, Rikita Hospital, Hiroshima, Japan.,Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroshi Iwamoto
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shinichiro Ohshimo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yu Wakabayashi
- Department of Internal Medicine, Rikita Hospital, Hiroshima, Japan.,Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Daisuke Ihara
- Department of Internal Medicine, Rikita Hospital, Hiroshima, Japan.,Department of Respiratory Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Kazunori Fujitaka
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hironobu Hamada
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Koichi Ono
- Department of Internal Medicine, Rikita Hospital, Hiroshima, Japan
| | - Noboru Hattori
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Uvizl R, Kolar M, Herkel T, Vobrova M, Langova K. Possibilities for modifying risk factors for the development of hospital-acquired pneumonia in intensive care patients: results of a retrospective, observational study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2017; 161:303-309. [DOI: 10.5507/bp.2017.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 03/31/2017] [Indexed: 11/23/2022] Open
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Kim DH, Huybrechts KF, Patorno E, Marcantonio ER, Park Y, Levin R, Abdurrob A, Bateman BT. Adverse Events Associated with Antipsychotic Use in Hospitalized Older Adults After Cardiac Surgery. J Am Geriatr Soc 2017; 65:1229-1237. [PMID: 28186624 DOI: 10.1111/jgs.14768] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To evaluate in-hospital adverse events associated with typical and atypical antipsychotic medications (APMs) after cardiac surgery. DESIGN Retrospective cohort study. SETTING Nationwide inpatient database, 2003 to 14. PARTICIPANTS Individuals (mean age 70) newly treated with oral atypical (n = 2,580) or typical (n = 1,126 APMs) after coronary artery bypass grafting or valve surgery (N = 3,706). MEASUREMENTS In-hospital mortality, arrhythmia, pneumonia, use of brain imaging (surrogate for oversedation and neurological events), and length of stay after drug initiation RESULTS: In the propensity score-matched cohort, median treatment duration was 3 days (interquartile range (IQR) 1-6 days) for atypical APMs and 2 days (IQR 1-3 days) for typical APMs. There were no large differences in in-hospital mortality (atypical 5.4%, typical 5.3%; risk difference (RD) = 0.1%, 95% confidence interval (CI) = -2.1 to 2.3%), arrhythmia (2.0% vs 2.2%; RD = 0.0%; 95% CI = -1.4 to 1.4%), pneumonia (16.1% vs 14.5%; RD = 1.6%, 95% CI = -1.9 to 5.0%), and length of stay (9.9 days vs 9.3 days; mean difference = 0.5 days, 95% CI = -1.2 to 2.2). Use of brain imaging was more common after initiating atypical APMs (17.3%) than after typical APMs (12.4%; RD = 4.9%, 95% CI = 1.4-8.4). CONCLUSION In hospitalized individuals who underwent cardiac surgery, short-term use of typical APMs was associated with risks of adverse events similar to those with atypical APMs. Moreover, greater use of brain imaging associated with atypical APMs suggests that these drugs may cause oversedation or adverse neurological events. Because of the low event rates, the analysis could not exclude modest differences in adverse events between atypical and typical APMs.
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Affiliation(s)
- Dae H Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Krista F Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Edward R Marcantonio
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Yoonyoung Park
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Raisa Levin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Abdurrahman Abdurrob
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Brian T Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Atrial natriuretic peptide therapy and in-hospital mortality in acute myocardial infarction patients undergoing percutaneous coronary intervention. Int J Cardiol 2016; 222:163-170. [DOI: 10.1016/j.ijcard.2016.07.159] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/13/2016] [Accepted: 07/26/2016] [Indexed: 02/01/2023]
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De Rijdt T, Spriet I, Willems L, Blanckaert M, Hiele M, Wilmer A, Simoens S. Appropriateness of Acid Suppression Therapy. Ann Pharmacother 2016; 51:125-134. [DOI: 10.1177/1060028016670414] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: The inappropriate startup of long-term acid suppressive therapy (AST) can have clinical and pharmacoeconomic impacts on ambulatory care. Objective: To assess the proportion of patients with appropriate initiation of long-term AST in non–critically ill patients. To describe possible risk factors for nonappropriate AST. To calculate the potential savings when eliminating the nonappropriate startup of AST. Method: This observational, retrospective study evaluated the appropriateness of startup of long-term AST in medical records using a broad variety of international criteria and guidelines and using a validated screening instrument. Results: A sample of 597 patients was included in the analysis. In 57% of them, AST was appropriately initiated. No specific risk profile could be defined. There was some indication that the availability of a clinical pharmacist and the use of standing orders were correlated to the outcome. Extrapolation to the total population (ie, 2836 patients) led to a total cost of €8880 during hospital stay plus an extra €40 391 per month after discharge. Avoiding inappropriate initiation of AST could lead to a saving of €3805 plus €17 441 per month. Conclusion: In all, 43% of initiation of long-term AST in the hospital was inappropriate. The potential savings from avoiding this could be substantial from a health care payer perspective. No patient characteristics that could predict for inappropriate initiation of AST were identified. A correlation between inappropriate initiation and medical disciplines using standing orders that include AST was seen.
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Tagami T, Matsui H, Ishinokami S, Oyanagi M, Kitahashi A, Fukuda R, Unemoto K, Fushimi K, Yasunaga H. Amiodarone or nifekalant upon hospital arrival for refractory ventricular fibrillation after out-of-hospital cardiac arrest. Resuscitation 2016; 109:127-132. [PMID: 27568110 DOI: 10.1016/j.resuscitation.2016.08.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 08/02/2016] [Accepted: 08/10/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND We evaluated the association between nifekalant or amiodarone on hospital admission and in-hospital mortality for cardiac arrest patients with persistent ventricular fibrillation on hospital arrival. METHODS This was a retrospective cohort study using the Japanese Diagnosis Procedure Combination inpatient database. We identified 2961 patients who suffered cardiogenic out-of-hospital cardiac arrest and who had ventricular fibrillation on hospital arrival between July 2007 and March 2013. Patients were categorized into amiodarone (n=2353) and nifekalant (n=608) groups, from which 525 propensity score-matched pairs were generated. RESULTS We found a significant difference in the admission rate between the nifekalant and amiodarone groups in propensity score-matched groups (75.6% vs. 69.3%, respectively; difference, 6.3%; 95% confidence interval (CI), 0.9-11.7). An analysis using the hospital nifekalant/amiodarone rate as an instrumental variable found that receiving nifekalant was associated with an improved admission rate (22.2%, 95% CI, 11.9-32.4). We found no significant difference in in-hospital mortality between the nifekalant and amiodarone groups (81.5% vs. 82.1%, respectively; difference, -0.6%; 95% CI, -5.2 to 4.1). Instrumental variable analysis showed that receiving nifekalant was not associated with reduced in-hospital mortality (6.2%, 95% CI, -2.4 to 14.8). CONCLUSIONS This nationwide study suggested no significant in-hospital mortality association between nifekalant and amiodarone for cardiogenic out-of-hospital cardiac arrest patients with ventricular fibrillation/persistent ventricular tachycardia on hospital arrival. Although nifekalant may potentially improve hospital admission rates compared with amiodarone for these patients, further studies are required to confirm our results.
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Affiliation(s)
- Takashi Tagami
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Japan; Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Japan.
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Japan
| | - Saori Ishinokami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Japan
| | - Masao Oyanagi
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Japan
| | - Akiko Kitahashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Japan
| | - Reo Fukuda
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Japan
| | - Kyoko Unemoto
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Japan
| | - Kiyohide Fushimi
- Department of Health Informatics and Policy, Tokyo Medical and Dental University, Graduate School of Medicine, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Japan
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Abstract
Patients undergoing aortic arch surgery are at high risk for stroke, delirium, low cardiac output, respiratory failure, renal failure, and coagulopathy. A significantly higher mortality is seen in patients experiencing any of these complications when compared with those without complications. As surgical, perfusion, and anesthetic techniques improve, the incidence of major complications have decreased. A recent paradigm shift in cardiac surgery has focused on rapid postoperative recovery, and a similar change has affected the care of patients after arch surgery. Nevertheless, a small subset of patients experience significant morbidity and mortality after aortic arch surgery, and rapid identification of any organ dysfunction and appropriate supportive care is critical in these patients. In this article, the current state of postoperative care of the patient after open aortic arch surgery will be reviewed.
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Abstract
BACKGROUND Practice guidelines for perioperative pain management recommend that multimodal analgesic therapy should be used for all postsurgical patients. However, the proportion of patients who actually receive this evidence-based approach is unknown. The objective of this study was to describe hospital-level patterns in the utilization of perioperative multimodal analgesia. METHODS Data for the study were obtained from the Premier Research Database. Patients undergoing below-knee amputation, open lobectomy, total knee arthroplasty, and open colectomy between 2007 and 2014 were included in the analysis. Patients were considered to have multimodal therapy if they received one or more nonopioid analgesic therapies. Mixed-effects logistic regression models were used to estimate the hospital-specific frequency of multimodal therapy use while adjusting for the case mix of patients and hospital characteristics and accounting for random variation. RESULTS The cohort consisted of 799,449 patients who underwent a procedure at 1 of 315 hospitals. The mean probability of receiving multimodal therapy was 90.4%, with 95% of the hospitals having a predicted probability between 42.6 and 99.2%. A secondary analysis examined whether patients received two or more nonopioid analgesics, which gave an average predicted probability of 54.2%, with 95% of the hospitals having a predicted probability between 9.3 and 93.2%. CONCLUSIONS In this large nationwide sample of surgical admissions in the United States, the authors observed tremendous variation in the utilization of multimodal therapy not accounted for by patient or hospital characteristics. Efforts should be made to identify why there are variations in the use of multimodal analgesic therapy and to promote its adoption in appropriate patients.
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Riera M, Amézaga R, Molina M, Campillo-Artero C, Sáez de Ibarra JI, Bonnín O, Ibáñez J. [Mortality from postoperative complications (failure to rescue) after cardiac surgery in a university hospital]. ACTA ACUST UNITED AC 2016; 31:126-33. [PMID: 27211493 DOI: 10.1016/j.cali.2016.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 03/04/2016] [Accepted: 03/07/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study analyses the rate of post-operative complications after cardiac surgery, the incidence of the failure to rescue (FR), and the relationship between complications and survival. METHODS The study included a total of 2,750 adult patients operated of cardiac surgery between January 2003 and December 2009. An analysis was made of 9 post-operative complications. Multiple logistic regression analysis was used to find independent variables associated with any of the selected complications. Survival was analysed with Kaplan-Meyer survival estimates. A risk-adjusted Cox proportional regression model was used to find out which complications were associated with mid-term survival. RESULTS Hospital mortality rate was 1.4% (95% CI: 1.0%-1.9%). Postoperative complications rate was 38.5% (36.7%-40.4%), and FR 3.6% (2.5%-4.9%). Urgent surgery (OR = 2.03; 1.52-2.72), chronic renal failure (OR = 1.50, 95%.CI: 1.25-1.80), and age ≥70 years (OR = 1.42; 1.20-1.68) were the variables that showed the highest strength of association with the selected complications. Survival at 5 years in the group of patients without complications was 93%, and in the group of patients with complications it was 83% (P<.0001). Postoperative complications associated with mid-term survival were pneumonia (HR = 2.6, 95% CI; 1.27-5.50), acute myocardial infarction (HR = 1.9; 1.10-2.30), and acute renal failure (HR = 1.7; 1.30-2.26). CONCLUSIONS The incidence of complications after cardiac surgery is around 40%, and was associated with an increase in hospital mortality, although FR was very low (3.6%; 95% CI: 2.5-4.9).
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Affiliation(s)
- M Riera
- Unidad de Cuidados Intensivos, Hospital Universitari Son Espases, Palma de Mallorca, Islas Baleares, España.
| | - R Amézaga
- Unidad de Cuidados Intensivos, Hospital Universitari Son Espases, Palma de Mallorca, Islas Baleares, España
| | - M Molina
- Unidad de Cuidados Intensivos, Hospital Universitari Son Espases, Palma de Mallorca, Islas Baleares, España
| | - C Campillo-Artero
- Servei de Salut de les Illes Balears, Palma de Mallorca, CRES-UPF, Barcelona, España
| | - J I Sáez de Ibarra
- Servicio de Cirugía Cardiaca, Hospital Universitari Son Espases, Palma de Mallorca, Islas Baleares, España
| | - O Bonnín
- Servicio de Cirugía Cardiaca, Hospital Universitari Son Espases, Palma de Mallorca, Islas Baleares, España
| | - J Ibáñez
- Unidad de Cuidados Intensivos, Hospital Universitari Son Espases, Palma de Mallorca, Islas Baleares, España
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Proton Pump Inhibitors versus Histamine-2 Receptor Antagonists and Risk of Pneumonia in Patients with Acute Stroke. J Stroke Cerebrovasc Dis 2016; 25:1035-1040. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.01.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 12/10/2015] [Accepted: 01/11/2016] [Indexed: 11/22/2022] Open
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Isogai T, Matsui H, Tanaka H, Fushimi K, Yasunaga H. Early β-blocker use and in-hospital mortality in patients with Takotsubo cardiomyopathy. Heart 2016; 102:1029-35. [DOI: 10.1136/heartjnl-2015-308712] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 01/25/2016] [Indexed: 12/15/2022] Open
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Carroll R, Corcoran P, Griffin E, Perry I, Arensman E, Gunnell D, Metcalfe C. Variation between hospitals in inpatient admission practices for self-harm patients and its impact on repeat presentation. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1485-1493. [PMID: 27300340 PMCID: PMC5101268 DOI: 10.1007/s00127-016-1247-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 05/27/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE Self-harm patient management varies markedly between hospitals, with fourfold differences in the proportion of patients who are admitted to a medical or psychiatric inpatient bed. The current study aimed to investigate whether differences in admission practices are associated with patient outcomes (repeat self-harm) while accounting for differences in patient case mix. METHODS Data came from the National Self-Harm Registry Ireland. A prospective cohort of 43,595 self-harm patients presenting to hospital between 2007 and 2012 were included. As well as conventional regression analysis, instrumental variable (IV) methods utilising between hospital differences in rates of hospital admission were used in an attempt to gain unbiased estimates of the association of admission with risk of repeat self-harm. RESULTS The proportion of self-harm patients admitted to a medical bed varied from 10 to 74 % between hospitals. Conventional regression and IV analysis suggested medical admission was not associated with risk of repeat self-harm. Psychiatric inpatient admission was associated with an increased risk of repeat self-harm in both conventional and IV analyses. This increased risk persisted in analyses stratified by gender and when restricted to self-poisoning patients only. CONCLUSIONS No strong evidence was found to suggest medical admission reduces the risk of repeat self-harm. Models of health service provision that encourage prompt mental health assessment in the emergency department and avoid unnecessary medical admission of self-harm patients appear warranted. Psychiatric inpatient admission may be associated with a heightened risk of repeat self-harm in some patients, but these findings could be biased by residual confounding and require replication.
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Affiliation(s)
- R. Carroll
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - P. Corcoran
- National Suicide Research Foundation, University College Cork, Cork, Ireland ,Department of Epidemiology and Public Health, University College Cork, Cork, Ireland ,Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - E. Griffin
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - I. Perry
- National Suicide Research Foundation, University College Cork, Cork, Ireland ,Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - E. Arensman
- National Suicide Research Foundation, University College Cork, Cork, Ireland ,Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - D. Gunnell
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - C. Metcalfe
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
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How Do You Treat Gastroesophageal Reflux Disease in Your Practice? Med Acupunct 2015. [DOI: 10.1089/acu.2015.29004.cpl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Gagne JJ, Polinski JM, Rassen JA, Fischer MA, Seeger JD, Franklin JM, Liu J, Schneeweiss S, Choudhry NK. Selective Serotonin Reuptake Inhibitor Use and Perioperative Bleeding and Mortality in Patients Undergoing Coronary Artery Bypass Grafting: A Cohort Study. Drug Saf 2015; 38:1075-82. [DOI: 10.1007/s40264-015-0328-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Tagami T, Matsui H, Fushimi K, Yasunaga H. Intravenous Immunoglobulin and Mortality in Pneumonia Patients With Septic Shock: An Observational Nationwide Study. Clin Infect Dis 2015; 61:385-92. [DOI: 10.1093/cid/civ307] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 03/21/2015] [Indexed: 12/22/2022] Open
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Tagami T, Matsui H, Fushimi K, Yasunaga H. Intravenous immunoglobulin use in septic shock patients after emergency laparotomy. J Infect 2015; 71:158-66. [PMID: 25869539 DOI: 10.1016/j.jinf.2015.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 03/18/2015] [Accepted: 04/03/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The role of intravenous immunoglobulin (IVIG) as an adjunctive treatment for abdominal sepsis remains controversial. METHODS Mechanically ventilated septic shock patients following emergency laparotomy for perforation of the lower intestinal tract were identified in the Japanese Diagnosis Procedure Combination inpatient database from July 2010 to March 2013. The effect of IVIG use on 28-day mortality was evaluated using propensity score and instrumental variable analyses. RESULTS Eligible patients (n = 4919) treated at 845 hospitals were divided into IVIG (n = 2085) and control (n = 2834) groups. Propensity score matching created a matched cohort of 1081pairs with and without IVIG treatment. Although significant mortality differences existed between the IVIG and control groups in the unmatched analysis (20.6% vs. 18.3%; difference, 2.3%; 95% confidence interval [CI], 0.07-4.5), there were no significant differences in the propensity score-matched analysis (20.4% vs. 19.3%; difference, 1.1%; 95% CI, -2.3-4.5). Analysis employing the pattern of hospital IVIG use as an instrumental variable showed that IVIG use was not associated with reduced mortality (difference -2.5; 95% CI, -6.5-1.6). CONCLUSIONS There may be no significant association between IVIG use and mortality in mechanically ventilated septic shock patients after emergency laparotomy.
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Affiliation(s)
- Takashi Tagami
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8555, Japan; Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8555, Japan.
| | - Kiyohide Fushimi
- Department of Health Informatics and Policy, Tokyo Medical and Dental University, Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8555, Japan.
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Laborde-Castérot H, Agrinier N, Thilly N. Performing both propensity score and instrumental variable analyses in observational studies often leads to discrepant results: a systematic review. J Clin Epidemiol 2015; 68:1232-40. [PMID: 26026496 DOI: 10.1016/j.jclinepi.2015.04.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 03/18/2015] [Accepted: 04/02/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Propensity score (PS) and instrumental variable (IV) are analytical techniques used to adjust for confounding in observational research. More and more, they seem to be used simultaneously in studies evaluating health interventions. The present review aimed to analyze the agreement between PS and IV results in medical research published to date. STUDY DESIGN AND SETTING Review of all published observational studies that evaluated a clinical intervention using simultaneously PS and IV analyses, as identified in MEDLINE and Web of Science. RESULTS Thirty-seven studies, most of them published during the previous 5 years, reported 55 comparisons between results from PS and IV analyses. There was a slight/fair agreement between the methods [Cohen's kappa coefficient = 0.21 (95% confidence interval: 0.00, 0.41)]. In 23 cases (42%), results were nonsignificant for one method and significant for the other, and IV analysis results were nonsignificant in most situations (87%). CONCLUSION Discrepancies are frequent between PS and IV analyses and can be interpreted in various ways. This suggests that researchers should carefully consider their analytical choices, and readers should be cautious when interpreting results, until further studies clarify the respective roles of the two methods in observational comparative effectiveness research.
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Affiliation(s)
- Hervé Laborde-Castérot
- Lorraine University, Paris-Descartes University, EA 4360 Apemac, Avenue de la forêt de Haye, 54500 Vandoeuvre-lès-Nancy, France; Université Paris 13, Sorbonne Paris Cité, UFR SMBH, 1 rue de Chablis, 93017, Bobigny, France
| | - Nelly Agrinier
- Lorraine University, Paris-Descartes University, EA 4360 Apemac, Avenue de la forêt de Haye, 54500 Vandoeuvre-lès-Nancy, France; Clinical Epidemiology and Evaluation, CIC-EC CIE6 Inserm, University Hospital of Nancy, Allée du Morvan, 54500 Vandoeuvre-lès-Nancy, France
| | - Nathalie Thilly
- Lorraine University, Paris-Descartes University, EA 4360 Apemac, Avenue de la forêt de Haye, 54500 Vandoeuvre-lès-Nancy, France; Clinical Epidemiology and Evaluation, CIC-EC CIE6 Inserm, University Hospital of Nancy, Allée du Morvan, 54500 Vandoeuvre-lès-Nancy, France.
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Tagami T, Matsui H, Yasunaga H. Antithrombin or thrombomodulin administration in severe pneumonia patients with sepsis and disseminated intravascular coagulation: reply to two papers. J Thromb Haemost 2015; 13:686-8. [PMID: 25650788 DOI: 10.1111/jth.12869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- T Tagami
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
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Ubben JF, Lance MD, Buhre WF, Schreiber JU. Clinical Strategies to Prevent Pulmonary Complications in Cardiac Surgery: An Overview. J Cardiothorac Vasc Anesth 2015; 29:481-90. [DOI: 10.1053/j.jvca.2014.09.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Indexed: 11/11/2022]
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Tagami T, Matsui H, Fushimi K, Yasunaga H. Use of recombinant human soluble thrombomodulin in patients with sepsis-induced disseminated intravascular coagulation after intestinal perforation. Front Med (Lausanne) 2015; 2:7. [PMID: 25767801 PMCID: PMC4341430 DOI: 10.3389/fmed.2015.00007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 02/08/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Anticoagulant therapy has been evaluated with respect to its potential usefulness in reducing the high mortality rates associated with severe sepsis, including sepsis-induced disseminated intravascular coagulation (DIC) after intestinal perforation. We examined the hypothesis that recombinant human soluble thrombomodulin (rhTM) is effective in the treatment of patients with septic shock with sepsis-induced DIC after laparotomy for intestinal perforation. METHODS We performed propensity-score and instrumental variable analyses of the Japanese Diagnosis Procedure Combination in-patient database, a nationwide administrative database. The main outcome was 28-day in-hospital all-cause mortality. RESULTS We categorized eligible patients (n = 2202) from 622 hospitals into the rhTM group (n = 726) and control group (n = 1476). Propensity-score matching created 621 matched pairs of patients with and without rhTM. There was neither significant difference in 28-day mortality between the two groups in the unmatched analysis (rhTM vs. control, 25.3 vs. 23.4%, respectively; difference, 1.9%; 95% CI, -1.9 to 5.7) nor in the propensity-score-matched analysis (rhTM vs. control, 26.1 vs. 24.8%, respectively; difference, 1.3%; 95% CI, -3.6 to 6.1). The logistic analysis showed no significant association between the use of rhTM and the mortality in propensity-score-matched patients (OR, 1.1; 95% CI, 0.82-1.4). The instrumental variable analyses, using the hospital rhTM-prescribing proportion as the variable, found that receipt of rhTM was not associated with the reduction in the mortality (risk difference, -6.7%; 95% CI, -16.4 to 3.0). CONCLUSION We found no association between administration of rhTM and 28-day mortality in mechanically ventilated patients with septic shock and concurrent DIC after intestinal perforation.
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Affiliation(s)
- Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Informatics and Policy, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Momosaki R, Yasunaga H, Matsui H, Horiguchi H, Fushimi K, Abo M. Effect of Early Rehabilitation by Physical Therapists on In-hospital Mortality After Aspiration Pneumonia in the Elderly. Arch Phys Med Rehabil 2015; 96:205-9. [DOI: 10.1016/j.apmr.2014.09.014] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 09/08/2014] [Accepted: 09/10/2014] [Indexed: 11/25/2022]
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Bateman BT, Tsen LC, Liu J, Butwick AJ, Huybrechts KF. Patterns of second-line uterotonic use in a large sample of hospitalizations for childbirth in the United States: 2007-2011. Anesth Analg 2015; 119:1344-9. [PMID: 25166464 DOI: 10.1213/ane.0000000000000398] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The incidence of postpartum hemorrhage due to uterine atony has increased significantly in the United States during the past decade. For patients with refractory uterine atony after oxytocin administration, second-line uterotonics including methylergonovine maleate, carboprost, and misoprostol are recommended. In this study, we describe hospital-level patterns of second-line uterotonic use in a large, nationwide sample of admissions for childbirth in the United States. METHODS The Premier Research Database was used to define a cohort of 2,180,916 patients hospitalized for delivery at 1 of 367 hospitals from 2007 to 2011. Mixed-effects logistic regression models were used to estimate the hospital-specific frequency of second-line uterotonic use adjusting for measured patient-level and hospital-level characteristics that might be risk factors for uterine atony. RESULTS The median hospital-level frequency of second-line uterotonic use was 7.1% (interquartile range 5.2-% to 10.8%). In the fully adjusted model, the mean (SE) predicted probability of second-line uterotonic use was 7.02% (0.26%), with 95% of the hospitals having a predicted (SE) probability between 1.69% (0.12%) and 24.96% (1.28%). CONCLUSIONS We observed wide interhospital variation in the use of second-line uterotonics that was not explained by patient-level or hospital-level characteristics. Studies aimed at defining the optimal pharmacologic strategies for the management of uterine atony are needed, particularly in light of the increasing incidence of atonic postpartum hemorrhage in the United States and other developed countries.
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Affiliation(s)
- Brian T Bateman
- From the *Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; †Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; ‡Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and §Department of Anesthesia, Stanford University School of Medicine, Stanford, California
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Tagami T, Matsui H, Horiguchi H, Fushimi K, Yasunaga H. Recombinant human soluble thrombomodulin and mortality in severe pneumonia patients with sepsis-associated disseminated intravascular coagulation: an observational nationwide study. J Thromb Haemost 2015; 13:31-40. [PMID: 25393713 DOI: 10.1111/jth.12786] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 11/06/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND The association between recombinant human soluble thrombomodulin (rhTM) use and mortality in patients with sepsis-associated disseminated intravascular coagulation (DIC) remains controversial. OBJECTIVES To examine the hypothesis that rhTM could be effective in the treatment of patients with sepsis-associated DIC following severe pneumonia. METHODS Propensity score and instrumental variable analyses using a nationwide administrative database, the Japanese Diagnosis Procedure Combination inpatient database, were used. The main outcome was 28-day in-hospital all-cause mortality. RESULTS Eligible patients (n = 6342) from 936 hospitals were categorized into the rhTM group (n = 1280) or control group (n = 5062). Propensity score matching created a matched cohort of 1140 pairs with and without rhTM. No significant difference in 28-day mortality was documented between the two groups in the unmatched analysis (rhTM vs. control, 37.0%, 474/1280 vs. 36.9%, 1866/5062; odds ratio [OR], 1.00; 95%CI, 0.98-1.03), nor in the propensity-matched analysis (37.6%, 429/1140 vs. 37.0%, 886/1140; OR, 1.01; 95%CI, 0.93-1.10). The logistic regression analysis did not show a significant association between the use of rhTM and 28-day mortality in propensity-matched patients (OR, 1.00; 95%CI, 0.87-1.22). An analysis using the hospital rhTM-prescribing rate as an instrumental variable found that receipt of rhTM was not associated with reduction in mortality at 28 days (risk difference, 0.008; 95% CI, -0.08-0.98). CONCLUSIONS This large retrospective nationwide study demonstrated that there might be little association between the use of rhTM and mortality in severe pneumonia patients with sepsis-associated DIC. A multinational randomized trial is required to confirm this.
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Affiliation(s)
- T Tagami
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan; Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
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MacLaren R, Kassel LE, Kiser TH, Fish DN. Proton pump inhibitors and histamine-2 receptor antagonists in the intensive care setting: focus on therapeutic and adverse events. Expert Opin Drug Saf 2014; 14:269-80. [DOI: 10.1517/14740338.2015.986456] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Proton pump inhibitor use represents an independent risk factor for myocardial infarction. Int J Cardiol 2014; 177:292-7. [PMID: 25499395 DOI: 10.1016/j.ijcard.2014.09.036] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 09/16/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND There is substantial debate regarding the development of acute coronary syndrome in patients using proton pump inhibitors (PPIs) combined with clopidogrel. However, data remain limited to address the effect of PPIs alone on the subsequent risk of myocardial infarction (MI). We aimed to explore the subsequent risk of MI in PPI users who had no previous history of MI. METHODS The records of inpatients and outpatients with PPI prescriptions were retrieved from the Taiwan National Health Insurance Research Database between 2000 and 2009. We conducted two different study designs, the first using propensity score (PS)-matching analyses and the second using case-crossover analyses. The risk of developing MI for PPI users was analyzed in the PS-matched study. The association between risk of MI and prior PPI exposure was further validated in the case-crossover study. RESULTS In the PS-matched study, we included 126,367 PPI users and 126,367 PS-matched PPI non-users. After 120 days of follow-up, PPI use was associated with a 1.58-fold greater risk of MI (adjusted hazard ratio [HR] = 1.58, 95% confidence interval [CI] = 1.11 to 2.25). In the case-crossover study, adjusted odds ratios of PPI for MI risk were 4.61 (95% CI = 1.76 to 12.07) for the 7-day window and 3.47 (95% CI = 1.76 to 6.83) for the 14-day window. CONCLUSIONS Use of PPIs may be independently associated with an increased risk of MI. However, the benefits of PPIs may greatly outweigh the risks of adverse cardiovascular effects, with number needed to harm of 4357.
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Herzig SJ, Doughty C, Lahoti S, Marchina S, Sanan N, Feng W, Kumar S. Acid-suppressive medication use in acute stroke and hospital-acquired pneumonia. Ann Neurol 2014; 76:712-8. [PMID: 25164323 DOI: 10.1002/ana.24262] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 07/24/2014] [Accepted: 08/22/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Pneumonia is a morbid complication of stroke, but evidence-based strategies for its prevention are lacking. Acid-suppressive medications have been associated with increased risk for nosocomial pneumonia in hospitalized patients. It is unclear whether these results can be extrapolated to stroke patients, where other factors strongly modulate pneumonia risk. We investigated the association between acid-suppressive medication and hospital-acquired pneumonia in patients with acute stroke. METHODS All patients hospitalized with acute ischemic stroke or intracerebral hemorrhage in a large, urban academic medical center in Boston, Massachusetts from June 2000 to June 2010 who were ≥18 years of age and hospitalized for ≥2 days were eligible for inclusion. Acid-suppressive medication use was defined as any pharmacy charge for a proton-pump inhibitor or histamine-2 receptor antagonist. Multivariate logistic regression was used to control for confounders. The main outcome measure was hospital-acquired pneumonia, defined via International Classification of Diseases, Ninth Revision, Clinical Modification codes. RESULTS The cohort comprised 1,676 admissions. Acid-suppressive medication was ordered in 1,340 (80%) and hospital-acquired pneumonia occurred in 289 (17.2%). The unadjusted incidence of hospital-acquired pneumonia was higher in the group exposed to acid-suppressive medication compared to those unexposed (20.7% vs 3.6%, odds ratio [OR] = 7.0, 95% confidence interval [CI] = 3.9-12.7). After adjustment, the OR of hospital-acquired pneumonia in the exposed group was 2.3 (95% CI = 1.2-4.6). The association was significant for proton-pump inhibitors (OR = 2.7, 95% CI = 1.4-5.4), but not for histamine-2 receptor antagonists (OR = 1.6, 95% CI = 0.8-3.4). INTERPRETATION In this large hospital-based cohort of patients presenting with acute stroke, acid-suppressive medication use was associated with increased odds of hospital-acquired pneumonia.
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Affiliation(s)
- Shoshana J Herzig
- Department of Medicine, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA
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