质子泵抑制剂与组胺 2 受体拮抗剂可能增加重症监护患者的死亡率：一项更新的荟萃分析。

Proton Pump Inhibitors Versus Histamine-2 Receptor Antagonists Likely Increase Mortality in Critical Care: An Updated Meta-Analysis.

机构信息

Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montréal, Québec, Canada; Centre for Outcomes Research and Evaluation (CORE), Department of Medicine, Research Institute, McGill University Health Centre, Montréal, Québec, Canada.

Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, Canada.

出版信息

Am J Med. 2021 Mar;134(3):e184-e188. doi: 10.1016/j.amjmed.2020.08.004. Epub 2020 Sep 12.

DOI:10.1016/j.amjmed.2020.08.004

PMID:32931766

Abstract

BACKGROUND

Upper gastrointestinal bleeding is common among the critically ill. Recently, the Proton Pump Inhibitors (PPIs) vs. Histamine-2 Receptor Blockers for Ulcer Prophylaxis Therapy in the Intensive Care Unit (PEPTIC) trial suggested PPIs might increase mortality. We performed an updated meta-analysis to further inform discussion.

METHODS

We leveraged 2 recent systematic reviews to identify randomized controlled trials directly comparing PPIs and H-2 Receptor Antagonists (H2RAs) for stress ulcer prophylaxis in critically ill patients and reporting mortality. We extracted mortality data from each study and meta-analyzed them with the PEPTIC trial using a random effects model.

RESULTS

Of 28,559 total patients, 14,436 (50.5%) were allocated to PPI and 14,123 to H2RAs (49.5%). Compared to H2RAs, the pooled relative risk for mortality was 1.05 (95% confidence interval 1.00-1.10) with an estimated risk difference for mortality of 9 additional deaths per 1000 patients exposed to PPI (95% confidence interval 0-18); heterogeneity was low (I = 0%; P = 0.826).

CONCLUSIONS

Stress ulcer prophylaxis with PPIs likely increases mortality compared to H2RAs. Whether stress ulcer prophylaxis is beneficial in critical care remains open to further study.

摘要

背景

上消化道出血在危重病患者中很常见。最近，质子泵抑制剂（PPIs）与组胺 2 受体阻滞剂用于重症监护病房（PEPTIC）的溃疡预防治疗试验表明，PPIs 可能会增加死亡率。我们进行了一项更新的荟萃分析，以进一步讨论这个问题。

方法

我们利用最近的两项系统评价，确定了直接比较 PPI 和 H2 受体拮抗剂（H2RAs）用于预防危重病患者应激性溃疡的随机对照试验，并报告了死亡率。我们从每项研究中提取死亡率数据，并使用随机效应模型与 PEPTIC 试验进行荟萃分析。

结果

在 28559 名患者中，有 14436 名（50.5%）被分配到 PPI 组，14123 名被分配到 H2RA 组（49.5%）。与 H2RAs 相比，死亡率的合并相对风险为 1.05（95%置信区间 1.00-1.10），估计 PPI 暴露每 1000 名患者增加 9 例死亡的风险差异（95%置信区间 0-18）；异质性较低（I = 0%；P = 0.826）。