Histamine-2 receptor antagonists versus proton pump inhibitors for septic shock after lower gastrointestinal tract perforation: a retrospective cohort study using a national inpatient database
Abstract Background Studies have shown the potential benefit of stress ulcer prophylaxis including histamine-2 receptor antagonists (H2RA) and proton pump inhibitors (PPI) in critically ill patients. However, the adverse effects of stress ulcer prophylaxis such as Clostridioides difficile infection...
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| Format: | Article |
| Language: | English |
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BMC
2020-07-01
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| Series: | Journal of Intensive Care |
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| Online Access: | http://link.springer.com/article/10.1186/s40560-020-00473-0 |
| _version_ | 1818967399278313472 |
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| author | Jun Suzuki Yusuke Sasabuchi Shuji Hatakeyama Hiroki Matsui Teppei Sasahara Yuji Morisawa Toshiyuki Yamada Hideo Yasunaga |
| author_facet | Jun Suzuki Yusuke Sasabuchi Shuji Hatakeyama Hiroki Matsui Teppei Sasahara Yuji Morisawa Toshiyuki Yamada Hideo Yasunaga |
| author_sort | Jun Suzuki |
| collection | DOAJ |
| description | Abstract Background Studies have shown the potential benefit of stress ulcer prophylaxis including histamine-2 receptor antagonists (H2RA) and proton pump inhibitors (PPI) in critically ill patients. However, the adverse effects of stress ulcer prophylaxis such as Clostridioides difficile infection (CDI) and hospital-acquired pneumonia have been reported. Abdominal septic shock is associated with increased risk of bleeding, CDI, and pneumonia; however, which ulcer prophylaxis might be associated with better outcomes in patients with septic shock after lower gastrointestinal tract perforation is unknown. Methods In this retrospective cohort study using the Japanese Diagnosis Procedure Combination database from July 2010 to March 2015, we identified patients aged 18 years or older who received open abdominal surgery for lower gastrointestinal tract perforation and who used vasopressors and antibiotics within 2 days of admission. We performed propensity score matching and inverse probability of treatment weighting (IPTW) to compare the outcomes between patients who received H2RA and those who received PPI within 2 days of admission. The outcomes included gastrointestinal bleeding requiring endoscopic hemostasis within 28 days of admission, 28-day mortality, CDI, and hospital-acquired pneumonia. Results The propensity score matching created 1088 pairs of patients who received H2RA or PPI within 2 days of admission. There were no significant differences between the H2RA and PPI groups regarding gastrointestinal bleeding requiring endoscopic hemostasis within 28 days of admission (0.74% vs 1.3%, risk ratio 0.57 (0.24–1.4), and P = 0.284), 28-day mortality (11.3% vs 12.9%, risk ratio 0.88 (0.68–1.1), and P = 0.386), CDI (0.64% vs 0.46%, risk ratio 1.4 (0.45–4.4), and P = 0.774), and hospital-acquired pneumonia (3.0% vs 4.3%, risk ratio 0.70 (0.45–1.1), and P = 0.138). IPTW analysis showed similar results. Conclusions There were no significant differences in gastrointestinal bleeding requiring endoscopic hemostasis within 28 days of admission, 28-day mortality, CDI, and hospital-acquired pneumonia between H2RA and PPI in patients with septic shock after lower gastrointestinal tract perforation. |
| first_indexed | 2024-12-20T13:48:11Z |
| format | Article |
| id | doaj.art-cb6bb11bbe384e958a05a9c1ab050987 |
| institution | Directory Open Access Journal |
| issn | 2052-0492 |
| language | English |
| last_indexed | 2024-12-20T13:48:11Z |
| publishDate | 2020-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Intensive Care |
| spelling | doaj.art-cb6bb11bbe384e958a05a9c1ab0509872022-12-21T19:38:36ZengBMCJournal of Intensive Care2052-04922020-07-01811810.1186/s40560-020-00473-0Histamine-2 receptor antagonists versus proton pump inhibitors for septic shock after lower gastrointestinal tract perforation: a retrospective cohort study using a national inpatient databaseJun Suzuki0Yusuke Sasabuchi1Shuji Hatakeyama2Hiroki Matsui3Teppei Sasahara4Yuji Morisawa5Toshiyuki Yamada6Hideo Yasunaga7Division of Infectious Diseases, Jichi Medical University HospitalData Science Center, Jichi Medical UniversityDivision of Infectious Diseases, Jichi Medical University HospitalDepartment of Clinical Epidemiology and Health Economics, School of Public Health, The University of TokyoDivision of Infectious Diseases, Jichi Medical University HospitalDivision of Infectious Diseases, Jichi Medical University HospitalDepartment of Clinical Laboratory Medicine, Jichi Medical UniversityDepartment of Clinical Epidemiology and Health Economics, School of Public Health, The University of TokyoAbstract Background Studies have shown the potential benefit of stress ulcer prophylaxis including histamine-2 receptor antagonists (H2RA) and proton pump inhibitors (PPI) in critically ill patients. However, the adverse effects of stress ulcer prophylaxis such as Clostridioides difficile infection (CDI) and hospital-acquired pneumonia have been reported. Abdominal septic shock is associated with increased risk of bleeding, CDI, and pneumonia; however, which ulcer prophylaxis might be associated with better outcomes in patients with septic shock after lower gastrointestinal tract perforation is unknown. Methods In this retrospective cohort study using the Japanese Diagnosis Procedure Combination database from July 2010 to March 2015, we identified patients aged 18 years or older who received open abdominal surgery for lower gastrointestinal tract perforation and who used vasopressors and antibiotics within 2 days of admission. We performed propensity score matching and inverse probability of treatment weighting (IPTW) to compare the outcomes between patients who received H2RA and those who received PPI within 2 days of admission. The outcomes included gastrointestinal bleeding requiring endoscopic hemostasis within 28 days of admission, 28-day mortality, CDI, and hospital-acquired pneumonia. Results The propensity score matching created 1088 pairs of patients who received H2RA or PPI within 2 days of admission. There were no significant differences between the H2RA and PPI groups regarding gastrointestinal bleeding requiring endoscopic hemostasis within 28 days of admission (0.74% vs 1.3%, risk ratio 0.57 (0.24–1.4), and P = 0.284), 28-day mortality (11.3% vs 12.9%, risk ratio 0.88 (0.68–1.1), and P = 0.386), CDI (0.64% vs 0.46%, risk ratio 1.4 (0.45–4.4), and P = 0.774), and hospital-acquired pneumonia (3.0% vs 4.3%, risk ratio 0.70 (0.45–1.1), and P = 0.138). IPTW analysis showed similar results. Conclusions There were no significant differences in gastrointestinal bleeding requiring endoscopic hemostasis within 28 days of admission, 28-day mortality, CDI, and hospital-acquired pneumonia between H2RA and PPI in patients with septic shock after lower gastrointestinal tract perforation.http://link.springer.com/article/10.1186/s40560-020-00473-0BleedingClostridioides difficile infectionHistamine-2 receptor antagonistsMortalityHospital-acquired pneumoniaProton pump inhibitors |
| spellingShingle | Jun Suzuki Yusuke Sasabuchi Shuji Hatakeyama Hiroki Matsui Teppei Sasahara Yuji Morisawa Toshiyuki Yamada Hideo Yasunaga Histamine-2 receptor antagonists versus proton pump inhibitors for septic shock after lower gastrointestinal tract perforation: a retrospective cohort study using a national inpatient database Journal of Intensive Care Bleeding Clostridioides difficile infection Histamine-2 receptor antagonists Mortality Hospital-acquired pneumonia Proton pump inhibitors |
| title | Histamine-2 receptor antagonists versus proton pump inhibitors for septic shock after lower gastrointestinal tract perforation: a retrospective cohort study using a national inpatient database |
| title_full | Histamine-2 receptor antagonists versus proton pump inhibitors for septic shock after lower gastrointestinal tract perforation: a retrospective cohort study using a national inpatient database |
| title_fullStr | Histamine-2 receptor antagonists versus proton pump inhibitors for septic shock after lower gastrointestinal tract perforation: a retrospective cohort study using a national inpatient database |
| title_full_unstemmed | Histamine-2 receptor antagonists versus proton pump inhibitors for septic shock after lower gastrointestinal tract perforation: a retrospective cohort study using a national inpatient database |
| title_short | Histamine-2 receptor antagonists versus proton pump inhibitors for septic shock after lower gastrointestinal tract perforation: a retrospective cohort study using a national inpatient database |
| title_sort | histamine 2 receptor antagonists versus proton pump inhibitors for septic shock after lower gastrointestinal tract perforation a retrospective cohort study using a national inpatient database |
| topic | Bleeding Clostridioides difficile infection Histamine-2 receptor antagonists Mortality Hospital-acquired pneumonia Proton pump inhibitors |
| url | http://link.springer.com/article/10.1186/s40560-020-00473-0 |
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