580 The Safety and Efficacy of Proton-Pump Inhibitors (PPI) Usage in Critical Care Patients for Stress Ulcer Prophylaxis: A Meta-Analysis of Randomized Controlled Trials

Abstract

INTRODUCTION: There is some debate in current literature about the safety and efficacy of proton pump inhibitor usage in critical care patients. In this systematic review and meta-analysis we assessed the the Safety and efficacy of proton-pump inhibitors (PPI) usage in critical care patients for stress ulcer prophylaxis METHODS: We searched PubMed, Embase, Web of Science and Cochrane Central Register of Controlled Trials following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement from inception until January 2019. We included randomized controlled trials (RCTs) that examined the efficacy and safety of proton pump inhibitors (PPIs) vs placebo regardless of publication source, status and language with participants older than 18 year old and of any gender who were admitted to medical, surgical or neuro intensive care unit (ICU). We excluded studies in which participants were admitted to ICUs primarily for the management of GI bleeding. Seven eligible studies were included and relevant data was extracted and statistical analysis was performed using Rev Man 5.3. RESULTS: Of 57 potentially eligible studies, we included 7 trials enrolling 4021 patients. The results showed that PPIs are probably more effective for preventing non clinically significant gastrointestinal bleed (GI bleed) [Odds ratio (OR) 0.47; 95% Confidence interval (95% CI) 0.37, 0.6] and clinically significant GI bleed -reported in 4 studies- (OR 0.59, 95% CI 0.40, 0.86). PPIs did not increase the risk of developing infection [including pneumonia and Clostridium difficile infection (c-diff) ] compared with placebo (OR 1.02, 95% CI 0.86, 1.22) even with sub analysis: pneumonia (OR 1.03, 95% CI 0.86, 1.23) and c-diff (OR .80, 95% CI 0.45, 1.44) . Estimates of baseline risks of bleeding varied significantly across studies, only 4 studies reported clinically significant GI bleed, 5 studies reported pneumonia (Definitions of pneumonia varied) and two studies reported on Clostridium difficile infection. CONCLUSION: PPI decreases the clinically significant and non-significant GI bleeding in critical care patients. PPI did not increase the risk of developing infection [including pneumonia and Clostridium difficile infection (c-diff) ] compared with placebo (OR 1.02, 95% CI 0.86, 1.22) even with sub analysis: pneumonia (OR 1.03, 95% CI 0.86, 1.23) and c-diff (OR .80, 95% CI 0.45, 1.44).