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Comparative Efficacy and Safety of Antiulcer Drugs for Stress Ulcer Prophylaxis (SUP) in Critically Ill Patients: A Systematic Review and Network Meta-Analysis

49 Pages Posted: 5 Aug 2018

See all articles by Pulin Yu

Pulin Yu

Harbin Medical University, Cancer Hospital, Department of Critical Care Medicine; Xi'an Jiaotong University (XJTU), Second Affiliated Hospital

Hongliang Wang

Harbin Medical University, Second Affiliated Hospital, Department of Critical Care Medicine

Haitao Liu

Harbin Medical University, Cancer Hospital, Department of Critical Care Medicine

Miao Liu

Harbin Medical University, Cancer Hospital, Department of Critical Care Medicine

Guiyue Wang

Harbin Medical University, Cancer Hospital, Department of Critical Care Medicine

Yuhang Li

Harbin Medical University, Cancer Hospital, Department of Critical Care Medicine

Yanji Lv

Harbin Medical University, Cancer Hospital, Department of Critical Care Medicine

Kaili Yu

Harbin Medical University, Cancer Hospital, Department of Critical Care Medicine

Xiaoya Zheng

Harbin Medical University, Cancer Hospital, Department of Critical Care Medicine

Yanjing Li

Harbin Medical University, Cancer Hospital, Department of Gastrointestinal Oncology

Tongsen Zheng

Harbin Medical University, Cancer Hospital, Department of Gastrointestinal Oncology

Ruitao Wang

Harbin Medical University, Cancer Hospital, Department of Internal Medicine

Fangfang Niu

Harbin Medical University, Cancer Hospital, Department of Critical Care Medicine

Yingnan Ju

Harbin Medical University, Cancer Hospital, Department of Critical Care Medicine

Peisong Xia

Harbin Medical University, Cancer Hospital, Department of Critical Care Medicine

Changsong Wang

Universiti Sains Malaysia (USM)

Kaijiang Yu

Harbin Medical University, Cancer Hospital, Department of Critical Care Medicine

More...

Abstract

Background: Stress ulcers can affect the prognosis of critically ill patients. However, is stress ulcer prophylaxis (SUP) necessary for critically ill patients? What is the best choice of SUP? There are no specific answers to these two questions. The aim of our study was to conduct a conventional pairwise meta-analysis to assess the effects of SUP versus no prophylaxis and to perform a network meta-analysis to evaluate the efficacy and safety of antiulcer drugs for SUP in adult critically ill patients.
Methods: We searched the Cochrane Central Register of Controlled Trials in the Cochrane Library, EMBASE, MEDLINE, CINAHL, and the Web of Science using a combination of MeSH and text  words relevant to SUP, critically ill patients, adults, proton pump inhibitors  (PPIs), histamine-2-receptor antagonists (H2RAs), sucralfate, and antacids, together with randomized controlled trials from the date of database inception to July 5, 2017. We extracted relevant information using a predefined data extraction form and assessed the risk of bias using the Cochrane risk of bias tool. Our primary outcome was the incidence of gastrointestinal (GI) bleeding. The secondary outcome was all-cause mortality and the risk of pneumonia.
Findings: A total of 73 randomized controlled trials, with a total of 10,509 adult critically ill patients, were identified in our study. In the pairwise meta-analysis, we found a statistically significant  difference between SUP and no prophylaxis for GI bleeding (RR 0·45, 95% CI 0·38 to 0·53) but no statistically significant differences in mortality (RR 0·96, 95% CI 0·84 to 1·10) or the risk of  pneumonia (RR 1·15, 95% CI 0·91 to 1·46). In a 5-node network meta-analysis, pooled effect sizes suggested that, compared to no prophylaxis, all interventions were associated with reduced GI bleeding. Additionally, compared to PPIs (RR 0·60, 95% CI 0·47 to 0·76) and H2RAs (RR 0·77, 95% CI 0·67 to 0·88), sucralfate was associated with a reduction in pneumonia. In an 11-node network meta-analysis, omeprazole was significantly more effective than cimetidine, ranitidine, and sucralfate in preventing GI bleeding, while compared to omeprazole, pantoprazole and ranitidine, sucralfate was associated with a decreased risk of pneumonia. In terms of mortality, the combined results showed no statistically significant differences in any comparisons.
Interpretation: SUP is necessary for preventing GI bleeding in adult critically ill patients. We recommend sucralfate as a better choice for SUP in adult critically ill patients.
Funding: This study was supported by grants from the National Natural Science Foundation of China (No. 81402462, 81571871 and 81770276) and the Yuweihan Fund for Distinguished Young Scholars.
Declaration of interests: We declare no competing interests.

Keywords: critically ill patients; histamine-2-receptor antagonists; prophylaxis; proton pump inhibitors; stress ulcers

Suggested Citation

Yu, Pulin and Wang, Hongliang and Liu, Haitao and Liu, Miao and Wang, Guiyue and Li, Yuhang and Lv, Yanji and Yu, Kaili and Zheng, Xiaoya and Li, Yanjing and Zheng, Tongsen and Wang, Ruitao and Niu, Fangfang and Ju, Yingnan and Xia, Peisong and Wang, Changsong and Yu, Kaijiang, Comparative Efficacy and Safety of Antiulcer Drugs for Stress Ulcer Prophylaxis (SUP) in Critically Ill Patients: A Systematic Review and Network Meta-Analysis (June 29, 2018). Available at SSRN: https://ssrn.com/abstract=3205565

Pulin Yu

Harbin Medical University, Cancer Hospital, Department of Critical Care Medicine

China

Xi'an Jiaotong University (XJTU), Second Affiliated Hospital

China

Hongliang Wang

Harbin Medical University, Second Affiliated Hospital, Department of Critical Care Medicine

China

Haitao Liu

Harbin Medical University, Cancer Hospital, Department of Critical Care Medicine

China

Miao Liu

Harbin Medical University, Cancer Hospital, Department of Critical Care Medicine

China

Guiyue Wang

Harbin Medical University, Cancer Hospital, Department of Critical Care Medicine

China

Yuhang Li

Harbin Medical University, Cancer Hospital, Department of Critical Care Medicine

China

Yanji Lv

Harbin Medical University, Cancer Hospital, Department of Critical Care Medicine

China

Kaili Yu

Harbin Medical University, Cancer Hospital, Department of Critical Care Medicine

China

Xiaoya Zheng

Harbin Medical University, Cancer Hospital, Department of Critical Care Medicine

China

Yanjing Li

Harbin Medical University, Cancer Hospital, Department of Gastrointestinal Oncology

China

Tongsen Zheng

Harbin Medical University, Cancer Hospital, Department of Gastrointestinal Oncology

China

Ruitao Wang

Harbin Medical University, Cancer Hospital, Department of Internal Medicine

China

Fangfang Niu

Harbin Medical University, Cancer Hospital, Department of Critical Care Medicine

China

Yingnan Ju

Harbin Medical University, Cancer Hospital, Department of Critical Care Medicine

China

Peisong Xia

Harbin Medical University, Cancer Hospital, Department of Critical Care Medicine

China

Changsong Wang (Contact Author)

Universiti Sains Malaysia (USM) ( email )

Jalan Sungai Dua
Minden, Penang 11800
Malaysia

Kaijiang Yu

Harbin Medical University, Cancer Hospital, Department of Critical Care Medicine ( email )

China

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