Dataset Information

The efficacy and safety of acid suppressants for gastrointestinal bleeding prophylaxis in cardiac care unit patients.

ABSTRACT:

Background and aim

Concerns regarding adverse events associated with proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs) for gastrointestinal bleeding (GIB) prophylaxis in the intensive care unit have increased in recent years. Few studies have focused on acid suppressant use in the cardiac care unit (CCU) setting exclusively. We performed a cohort study to determine the efficacy and safety of acid suppressants for GIB prophylaxis in CCU patients.

Methods

This retrospective cohort study included adults who were admitted directly to the CCU for more than 2 days from January 1, 2014, to April 30, 2019. The Crusade score was calculated to evaluate the risk of GIB. The primary outcomes were clinically important gastrointestinal bleeding (CIGIB), hospital-acquired pneumonia (HAP), and in-hospital mortality.

Results

Of the 3318 patients enrolled, 2284 (68.8%) patients received PPIs, 515 (15.5%) received H2RAs, and 519 (15.7%) received no acid suppressants. After adjusting for potential confounders, utilization of PPIs (2.69, 95% confidence interval [0.62-11.73]) and H2RAs (1.41, 95% confidence interval [0.19-10.36]) were not associated with a lower risk of CIGIB than the control. Sensitivity analyses revealed that PPI use was an independent risk factor for in-hospital mortality in patients over 75 years old, with an adjusted odds ratio of 4.08 (1.14-14.63). PPIs increased the risk of HAP in patients over 75 years old and in those with heart failure, with adjusted odds ratios of 2.38 (1.06-5.34) and 2.88 (1.34-7.28), respectively.

Conclusions

Proton pump inhibitors and H2RAs for GIB prophylaxis in CCU patients were not associated with a lower risk of CIGIB than the controls. PPI therapy is associated with increased risks of HAP and in-hospital mortality in patients over 75 years old. PPIs may increase the risk of HAP in patients with heart failure.

SUBMITTER: Chen C

PROVIDER: S-EPMC8451749 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:ObjectiveTo determine, in critically ill patients, the relative impact of proton pump inhibitors (PPIs), histamine-2 receptor antagonists (H2RAs), sucralfate, or no gastrointestinal bleeding prophylaxis (or stress ulcer prophylaxis) on outcomes important to patients.DesignSystematic review and network meta-analysis.Data sourcesMedline, PubMed, Embase, Cochrane Central Register of Controlled Trials, trial registers, and grey literature up to March 2019.Eligibility criteria for selecting studies and methodsWe included randomised controlled trials that compared gastrointestinal bleeding prophylaxis with PPIs, H2RAs, or sucralfate versus one another or placebo or no prophylaxis in adult critically ill patients. Two reviewers independently screened studies for eligibility, extracted data, and assessed risk of bias. A parallel guideline committee (BMJ Rapid Recommendation) provided critical oversight of the systematic review, including identifying outcomes important to patients. We performed random-effects pairwise and network meta-analyses and used GRADE to assess certainty of evidence for each outcome. When results differed between low risk and high risk of bias studies, we used the former as best estimates.ResultsSeventy two trials including 12?660 patients proved eligible. For patients at highest risk (>8%) or high risk (4-8%) of bleeding, both PPIs and H2RAs probably reduce clinically important gastrointestinal bleeding compared with placebo or no prophylaxis (odds ratio for PPIs 0.61 (95% confidence interval 0.42 to 0.89), 3.3% fewer for highest risk and 2.3% fewer for high risk patients, moderate certainty; odds ratio for H2RAs 0.46 (0.27 to 0.79), 4.6% fewer for highest risk and 3.1% fewer for high risk patients, moderate certainty). Both may increase the risk of pneumonia compared with no prophylaxis (odds ratio for PPIs 1.39 (0.98 to 2.10), 5.0% more, low certainty; odds ratio for H2RAs 1.26 (0.89 to 1.85), 3.4% more, low certainty). It is likely that neither affect mortality (PPIs 1.06 (0.90 to 1.28), 1.3% more, moderate certainty; H2RAs 0.96 (0.79 to 1.19), 0.9% fewer, moderate certainty). Otherwise, results provided no support for any affect on mortality, Clostridium difficile infection, length of intensive care stay, length of hospital stay, or duration of mechanical ventilation (varying certainty of evidence).ConclusionsFor higher risk critically ill patients, PPIs and H2RAs likely result in important reductions in gastrointestinal bleeding compared with no prophylaxis; for patients at low risk, the reduction in bleeding may be unimportant. Both PPIs and H2RAs may result in important increases in pneumonia. Variable quality evidence suggested no important effects of interventions on mortality or other in-hospital morbidity outcomes.Systematic review registrationPROSPERO CRD42019126656.

Project description:IntroductionThis study aims to construct a mortality prediction model for patients with non-variceal upper gastrointestinal bleeding (NVUGIB) in the intensive care unit (ICU), employing advanced machine learning algorithms. The goal is to identify high-risk populations early, contributing to a deeper understanding of patients with NVUGIB in the ICU.MethodsWe extracted NVUGIB data from the Medical Information Mart for Intensive Care IV (MIMIC-IV, v.2.2) database spanning from 2008 to 2019. Feature selection was conducted through LASSO regression, followed by training models using 11 machine learning methods. The best model was chosen based on the area under the curve (AUC). Subsequently, Shapley additive explanations (SHAP) was employed to elucidate how each factor influenced the model. Finally, a case was randomly selected, and the model was utilized to predict its mortality, demonstrating the practical application of the developed model.ResultsIn total, 2716 patients with NVUGIB were deemed eligible for participation. Following selection, 30 out of a total of 64 clinical parameters collected on day 1 after ICU admission remained associated with prognosis and were utilized for developing machine learning models. Among the 11 constructed models, the Gradient Boosting Decision Tree (GBDT) model demonstrated the best performance, achieving an AUC of 0.853 and an accuracy of 0.839 in the validation cohort. Feature importance analysis highlighted that shock, Glasgow Coma Scale (GCS), renal disease, age, albumin, and alanine aminotransferase (ALP) were the top six features of the GBDT model with the most significant impact. Furthermore, SHAP force analysis illustrated how the constructed model visualized the individualized prediction of death.ConclusionsPatient data from the MIMIC database were leveraged to develop a robust prognostic model for patients with NVUGIB in the ICU. The analysis using SHAP also assisted clinicians in gaining a deeper understanding of the disease.