Sarah Marchina1, Gheorghe Doros2, Janhavi Modak3, Johanna Helenius3, Dawn M Aycock4, Sandeep Kumar3. 1. Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA. Electronic address: smarchin@bidmc.harvard.edu. 2. Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA. 3. Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA. 4. Byrdine F. Lewis College of Nursing & Health Professions, Georgia State University, GA, USA.
Abstract
GOAL: We performed a systematic review and meta-analysis aiming to clarify the relationship between acid-suppressive medication (ASM) and the risk of pneumonia in acute stroke. METHODS: The included studies examined patients with an acute ischemic and/or hemorrhagic stroke, assessed the relationship of one or both groups of ASM, histamine-2 receptor antagonist (H2RA) and proton-pump inhibitor (PPI), as a variable of interest, and used the occurrence of hospital-acquired pneumonia (HAP) as an outcome measure. The search was conducted in MEDLINE, Cochrane, Embase, and Google Scholar. Random-effects meta-analyses were used to obtain pooled estimates of the effect. RESULTS: 5 retrospective cohort-studies fulfilled study criteria. The results revealed a higher risk of pneumonia for both, patients receiving PPI (adjusted relative risk [RR] 2.37, 95% confidence interval [CI] 1.36-4.17, I2 0%) and H2RAs (adjusted RR 1.73, 95% CI 0.74-4.25, I2 68.3%), although the latter did not reach statistical significance. A comparison of the overall acid versus non-acid groups using unadjusted values yielded likewise an increased risk for pneumonia for patients receiving ASM (unadjusted RR 4.65, 95% CI 1.64-13.16, I2 93.3%). CONCLUSION: Results of this meta-analysis show an increased risk for HAP in acute stroke patients who receive ASM, particularly those exposed to PPIs. Larger, well-controlled studies in acute stroke populations are needed to establish a clearer association between ASM and HAP. These results, however, urge caution when prescribing ASM - especially to stroke patients considered to be at high risk for pneumonia.
GOAL: We performed a systematic review and meta-analysis aiming to clarify the relationship between acid-suppressive medication (ASM) and the risk of pneumonia in acute stroke. METHODS: The included studies examined patients with an acute ischemic and/or hemorrhagic stroke, assessed the relationship of one or both groups of ASM, histamine-2 receptor antagonist (H2RA) and proton-pump inhibitor (PPI), as a variable of interest, and used the occurrence of hospital-acquired pneumonia (HAP) as an outcome measure. The search was conducted in MEDLINE, Cochrane, Embase, and Google Scholar. Random-effects meta-analyses were used to obtain pooled estimates of the effect. RESULTS: 5 retrospective cohort-studies fulfilled study criteria. The results revealed a higher risk of pneumonia for both, patients receiving PPI (adjusted relative risk [RR] 2.37, 95% confidence interval [CI] 1.36-4.17, I2 0%) and H2RAs (adjusted RR 1.73, 95% CI 0.74-4.25, I2 68.3%), although the latter did not reach statistical significance. A comparison of the overall acid versus non-acid groups using unadjusted values yielded likewise an increased risk for pneumonia for patients receiving ASM (unadjusted RR 4.65, 95% CI 1.64-13.16, I2 93.3%). CONCLUSION: Results of this meta-analysis show an increased risk for HAP in acute strokepatients who receive ASM, particularly those exposed to PPIs. Larger, well-controlled studies in acute stroke populations are needed to establish a clearer association between ASM and HAP. These results, however, urge caution when prescribing ASM - especially to strokepatients considered to be at high risk for pneumonia.
Authors: Shanna C Trenaman; Austin Harding; Susan K Bowles; Susan A Kirkland; Melissa K Andrew Journal: Front Pharmacol Date: 2022-06-22 Impact factor: 5.988