Comparison of Histamine-2 Receptor Antagonists and Proton Pump Inhibitors for Stress Ulcer Prophylaxis in Patients With Septic Shock
Abstract
OBJECTIVES
To compare the effectiveness of histamine-2 receptor antagonists (H2RAs) vs. proton pump inhibitors (PPIs) for stress ulcer prophylaxis on the occurrence of upper gastrointestinal bleeding (UGIB) and other clinical outcomes in hospitalized patients with septic shock.
DESIGN
Retrospective, multicenter, propensity-weighted cohort study.
SETTING
Conducted across 220 geographically diverse community and teaching hospitals in the United States.
PATIENTS
Adult patients (age ≥ 18 yr) with septic shock who were initiated on either H2RAs or PPIs on the day of hospital admission.
INTERVENTIONS
H2RAs (famotidine) or PPIs (pantoprazole, omeprazole, esomeprazole, or lansoprazole).
MEASUREMENTS AND MAIN RESULTS
The primary outcome was the occurrence of UGIB during hospitalization. Secondary outcomes included in-hospital mortality, ventilator-associated pneumonia, Clostridioides difficile infection, and hospital length of stay. Propensity scores with inverse probability of treatment weighting (IPTW) were used to control for confounding. Among 15,102 patients (5,492 H2RA, 9,610 PPI), the mean age was 65.8 ± 14.9 years, 47.8% were female, and 58.1% received invasive mechanical ventilation during hospitalization. After IPTW adjustment, PPI use was associated with a lower occurrence of UGIB compared with H2RA (odds ratio [OR], 0.78; 95% CI, 0.64-0.96; p = 0.016). A sensitivity analysis comparing famotidine to pantoprazole confirmed this finding (OR, 0.80; 95% CI, 0.65-0.97; p =…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 15,102 participants or records.
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