Effect of Acupuncture on Pneumonia Risk in Stroke Patients using Proton Pump Inhibitors: A Retrospective Case-Control Study

Abstract

Background

Stroke, the second leading cause of death globally, often requires the use of proton pump inhibitors (PPIs) to prevent gastrointestinal bleeding. However, the misuse of PPI can lead to pneumonia, and no current studies have explored the preventive effects of acupuncture on PPI-induced pneumonia.

Methods

A case-control study was conducted using data from the Tianjin Healthcare Bigdata Company covering stroke patients on PPI from January 1, 2016 to December 31, 2019. Patients with pneumonia during hospitalization from a stroke diagnosis were assigned to the case group, while those without pneumonia served as the control group. Propensity score matching was applied using a matching threshold set at 0.05. Matching characteristics included age, gender, dementia, Parkinsonism, gastric tube feeding, and oral disease. A logistic regression model was employed to evaluate the impact of acupuncture on the risk of pneumonia in stroke patients using PPI.

Results

In this case-control study, pneumonia occurred in 6389 (11.11%) stroke patients. Risk factors for pneumonia included suctioning phlegm and hospital stays. When the number of acupuncture sessions was treated as a continuous variable, each additional acupuncture session after the first was associated with a 6% reduction in the risk of pneumonia (odds ratio [OR]: 0.94; 95% confidence intervals [CI]: 0.93–0.95; p < 0.001). Multivariable logistic regression revealed that, compared to patients receiving acupuncture less than three times per visit, the risk of pneumonia was significantly reduced by 64% (OR: 0.36; 95% CI: 0.24–0.45; p < 0.001) for those receiving acupuncture 7–11 times per visit and by 79% (OR: 0.21; 95% CI: 0.16–0.27; p < 0.001) for those receiving acupuncture more than 11 times per visit. The highest quartile pneumonia risk was one-fifth of the lowest quartile.

Conclusion

In conclusion, this case-control study suggested that acupuncture may reduce pneumonia risk in stroke patients using PPI. Within a single visit, the best preventive effect was observed with more than 11 acupuncture sessions.