PMID- 32765885 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220416 IS - 2052-0492 (Print) IS - 2052-0492 (Electronic) IS - 2052-0492 (Linking) VI - 8 DP - 2020 TI - Histamine-2 receptor antagonists versus proton pump inhibitors for septic shock after lower gastrointestinal tract perforation: a retrospective cohort study using a national inpatient database. PG - 56 LID - 10.1186/s40560-020-00473-0 [doi] LID - 56 AB - 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. CI - (c) The Author(s) 2020. FAU - Suzuki, Jun AU - Suzuki J AUID- ORCID: 0000-0002-0316-5236 AD - Division of Infectious Diseases, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan. GRID: grid.415016.7. ISNI: 0000 0000 8869 7826 FAU - Sasabuchi, Yusuke AU - Sasabuchi Y AD - Data Science Center, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan. GRID: grid.410804.9. ISNI: 0000000123090000 FAU - Hatakeyama, Shuji AU - Hatakeyama S AD - Division of Infectious Diseases, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan. GRID: grid.415016.7. ISNI: 0000 0000 8869 7826 AD - Division of General Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan. GRID: grid.410804.9. ISNI: 0000000123090000 FAU - Matsui, Hiroki AU - Matsui H AD - 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: grid.26999.3d. ISNI: 0000 0001 2151 536X FAU - Sasahara, Teppei AU - Sasahara T AD - Division of Infectious Diseases, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan. GRID: grid.415016.7. ISNI: 0000 0000 8869 7826 AD - Department of Infection and Immunity, School of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan. GRID: grid.410804.9. ISNI: 0000000123090000 FAU - Morisawa, Yuji AU - Morisawa Y AD - Division of Infectious Diseases, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan. GRID: grid.415016.7. ISNI: 0000 0000 8869 7826 FAU - Yamada, Toshiyuki AU - Yamada T AD - Department of Clinical Laboratory Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan. GRID: grid.410804.9. ISNI: 0000000123090000 FAU - Yasunaga, Hideo AU - Yasunaga H AD - 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: grid.26999.3d. ISNI: 0000 0001 2151 536X LA - eng PT - Journal Article DEP - 20200731 PL - England TA - J Intensive Care JT - Journal of intensive care JID - 101627304 PMC - PMC7395359 OTO - NOTNLM OT - Bleeding OT - Clostridioides difficile infection OT - Histamine-2 receptor antagonists OT - Hospital-acquired pneumonia OT - Mortality OT - Peritonitis OT - Proton pump inhibitors COIS- Competing interestsThe authors have disclosed that they do not have any potential conflicts of interest. EDAT- 2020/08/09 06:00 MHDA- 2020/08/09 06:01 PMCR- 2020/07/31 CRDT- 2020/08/09 06:00 PHST- 2020/02/26 00:00 [received] PHST- 2020/07/22 00:00 [accepted] PHST- 2020/08/09 06:00 [entrez] PHST- 2020/08/09 06:00 [pubmed] PHST- 2020/08/09 06:01 [medline] PHST- 2020/07/31 00:00 [pmc-release] AID - 473 [pii] AID - 10.1186/s40560-020-00473-0 [doi] PST - epublish SO - J Intensive Care. 2020 Jul 31;8:56. doi: 10.1186/s40560-020-00473-0. eCollection 2020.