| アブストラクト | 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. |
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| ジャーナル名 | Journal of intensive care |
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| Pubmed追加日 | 2020/8/9 |
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| 投稿者 | Suzuki, Jun; Sasabuchi, Yusuke; Hatakeyama, Shuji; Matsui, Hiroki; Sasahara, Teppei; Morisawa, Yuji; Yamada, Toshiyuki; Yasunaga, Hideo |
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| 組織名 | Division of Infectious Diseases, Jichi Medical University Hospital, 3311-1;Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan.grid.415016.70000 0000 8869 7826;Data Science Center, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke,;Tochigi, 329-0498 Japan.grid.410804.90000000123090000;Division of General Medicine, Jichi Medical University, 3311-1 Yakushiji,;Shimotsuke, Tochigi, 329-0498 Japan.grid.410804.90000000123090000;Department of Clinical Epidemiology and Health Economics, School of Public;Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033;Japan.grid.26999.3d0000 0001 2151 536X;Department of Infection and Immunity, School of Medicine, Jichi Medical;University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498;Japan.grid.410804.90000000123090000;Department of Clinical Laboratory Medicine, Jichi Medical University, 3311-1;Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan.grid.410804.90000000123090000 |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/32765885/ |
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