PMID- 28085910
OWN - NLM
STAT- MEDLINE
DCOM- 20170808
LR  - 20181113
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 12
IP  - 1
DP  - 2017
TI  - Histamine H2-Blocker and Proton Pump Inhibitor Use and the Risk of Pneumonia in 
      Acute Stroke: A Retrospective Analysis on Susceptible Patients.
PG  - e0169300
LID - 10.1371/journal.pone.0169300 [doi]
LID - e0169300
AB  - BACKGROUND: Although histamine H2-blockers (H2B) and proton pump inhibitors (PPI) 
      are used commonly to prevent gastrointestinal bleeding in acute stroke, they are 
      implicated in the increased risk of pneumonia in other disease populations. In 
      acute stroke, the presence of distinctive risk factors of pneumonia, including 
      dysphagia and impaired consciousness, makes inclusive analysis vulnerable to 
      confounding. Our aim was to assess whether acid-suppressive drugs increase 
      pneumonia in acute stroke in a population controlled for confounding. METHODS: We 
      analyzed acute stroke patients admitted to a tertiary care hospital. To minimize 
      confounding, we only included subjects who could not feed orally during 14 days 
      of hospitalization. Exposure was defined as H2B or PPI, given in days; the 
      outcome was development of pneumonia within this period. The incidence was 
      calculated from the total number of pneumonias divided by the sum of person-days 
      at risk. We additionally performed multivariate Poisson regression and propensity 
      score analyses, although the restriction largely eliminated the need for 
      multivariate adjustment. RESULTS: A total of 132 pneumonias occurred in 3582 
      person-days. The incidence was 3.69%/person-day (95% confidence interval (CI); 
      3.03-4.37%/day). All subjects had dysphagia. Stroke severity and consciousness 
      disturbances were well-balanced between the groups exposed to H2B, PPI, or none. 
      The relative risk (RR) compared with the unexposed was 1.22 in H2B (95%CI; 
      0.83-1.81) and 2.07 in PPI (95% CI; 1.13-3.62). The RR of PPI compared with H2B 
      was 1.69 (95%CI; 0.95-2.89). In multivariate regression analysis, the RRs of H2B 
      and PPI were 1.24 (95% CI; 0.85-1.81) and 2.00 (95% CI; 1.12-3.57), respectively; 
      in propensity score analyses they were 1.17 (95% CI; 0.89-1.54) and 2.13 (95% CI; 
      1.60-2.84). CONCLUSIONS: The results of this study suggested that prophylactic 
      acid-suppressive therapy with PPI may have to be avoided in acute stroke patients 
      susceptible to pneumonia.
FAU - Arai, Nobuhiko
AU  - Arai N
AD  - Department of Neurological Surgery, Hiratsuka City Hospital, Hiratsuka City, 
      Kanagawa, Japan.
FAU - Nakamizo, Tomoki
AU  - Nakamizo T
AD  - Department of Neurology, Hiratsuka City Hospital, Hiratsuka City, Kanagawa, 
      Japan.
FAU - Ihara, Hikaru
AU  - Ihara H
AD  - Department of Neurology, Hiratsuka City Hospital, Hiratsuka City, Kanagawa, 
      Japan.
FAU - Koide, Takashi
AU  - Koide T
AD  - Department of Neurology, Hiratsuka City Hospital, Hiratsuka City, Kanagawa, 
      Japan.
FAU - Nakamura, Akiyoshi
AU  - Nakamura A
AD  - Department of Neurological Surgery, Hiratsuka City Hospital, Hiratsuka City, 
      Kanagawa, Japan.
FAU - Tabuse, Masanao
AU  - Tabuse M
AD  - Department of Neurological Surgery, Hiratsuka City Hospital, Hiratsuka City, 
      Kanagawa, Japan.
FAU - Miyazaki, Hiromichi
AU  - Miyazaki H
AD  - Department of Neurological Surgery, Hiratsuka City Hospital, Hiratsuka City, 
      Kanagawa, Japan.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20170113
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Histamine H2 Antagonists)
RN  - 0 (Proton Pump Inhibitors)
RN  - 820484N8I3 (Histamine)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - Histamine/*chemistry
MH  - Histamine H2 Antagonists/*adverse effects
MH  - Hospitalization
MH  - Humans
MH  - Incidence
MH  - Japan/epidemiology
MH  - Male
MH  - Pneumonia/chemically induced/*epidemiology
MH  - Propensity Score
MH  - Proton Pump Inhibitors/*adverse effects
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Stroke/complications/*drug therapy
PMC - PMC5234823
COIS- The authors have declared that no competing interests exist.
EDAT- 2017/01/14 06:00
MHDA- 2017/08/09 06:00
PMCR- 2017/01/13
CRDT- 2017/01/14 06:00
PHST- 2016/07/18 00:00 [received]
PHST- 2016/12/14 00:00 [accepted]
PHST- 2017/01/14 06:00 [entrez]
PHST- 2017/01/14 06:00 [pubmed]
PHST- 2017/08/09 06:00 [medline]
PHST- 2017/01/13 00:00 [pmc-release]
AID - PONE-D-16-28755 [pii]
AID - 10.1371/journal.pone.0169300 [doi]
PST - epublish
SO  - PLoS One. 2017 Jan 13;12(1):e0169300. doi: 10.1371/journal.pone.0169300. 
      eCollection 2017.