CLINICAL QUESTION: Does the timely cessation of proton pump inhibitors (PPIs) in critically ill patients impact morbidity and mortality compared to those who continue PPI therapy?
BACKGROUND: PPIs are commonly used to manage stress ulcers and gastrointestinal bleeding in critically ill patients. However, their use has been associated with potential risks, including increased rates of infections and adverse effects. Given the severity of conditions in critically ill patients, the timing of PPI discontinuation may play a critical role in influencing patient outcomes. This study explored whether stopping PPI therapy at an appropriate time can lead to better clinical outcomes, including reduced morbidity and mortality.
STUDY DESIGN: The study employed a propensity-score-matched cohort in a retrospective study. Matched groups of patients based on various baseline characteristics to control for confounding factors were created.
SETTING: Critical care settings at multiple hospitals
SYNOPSIS: PPIs are often started in the intensive care unit for stress ulcer prophylaxis, which itself is a controversial issue. The proportion of patients who continued PPI therapy without indication after leaving the intensive care unit in this study was 41.7%. These patients had a 27% greater risk of pneumonia (OR, 1.27; 95% confidence interval [CI], 1.15 to 1.39; P <0.001) and a 17% greater risk of cardiovascular events (OR, 1.17; 95% CI, 1.08 to 1.26; P <0.001). Continued PPI therapy was associated with a 34% greater risk of re-hospitalization (OR, 1.34; 95% CI, 1.23 to 1.47) and a nearly 20% greater two-year mortality risk (hazard ratio, 1.17; 95% CI, 1.08 to 1.27; P = 0.006).
BOTTOM LINE: Timely cessation of PPIs in critically ill patients is associated with a significant reduction in both morbidity and mortality. The study suggests that reconsidering the duration of PPI therapy and implementing a strategy for its timely discontinuation could enhance patient outcomes in formerly critically ill patients.
CITATION: Palmowski L, et al. Timely cessation of proton pump inhibitors in critically ill patients impacts morbidity and mortality: a propensity score-matched cohort study. Crit Care Med. 2024;52(2):190-199. doi: 10.1097/ CCM.0000000000006104.
Dr. Roomiany
Dr. Roomiany is a hospitalist at Duke Regional Hospital and an assistant professor in the department of medicine at Duke University School of Medicine in Durham, N.C.