Proton Pump Inhibitor Use Before ICU Admission Is Not Associated With Mortality of Critically Ill Patients.

Abstract

Some studies have shown that the long-term use of proton pump inhibitors (PPIs) is associated with many adverse events that may increase mortality; however, the relationship between premorbid PPI use and in-hospital mortality has yet to be validated in critically ill patients. Therefore, we performed this study to determine whether the preadmission use of PPIs is associated with mortality in patients admitted to the intensive care unit. This was a retrospective study with a large and freely accessible database in critical-care medicine (the Multiparameter Intelligent Monitoring in Intensive Care III project). The clinical data and outcomes of 17 473 patients, consisting of 1895 in the PPI group, 514 in the H₂ -receptor antagonist group, and 15 064 control subjects, were collected during their hospital stay. The study outcome was in-hospital mortality. A total of 17 473 patients were included in our study. PPI use was associated with significantly increased in-hospital mortality in the original model without adjustment for any parameters (odds ratio 1.19; 95%CI 1.03-1.38; P = .02). However, after adjustments had been made for age, sex, Elixhauser score, Simplified Acute Physiology Score, laboratory results, vasopressor use, ventilator use, and other parameters, PPIs were not associated with significantly increased in-hospital mortality (odds ratio 1.04; 95%CI 0.87-1.26; P = .614). In the subgroup analysis among patients with renal or liver disease, we still found that PPIs were not associated with a significant increase in in-hospital mortality. We found no association between PPI use before ICU admission and increased in-hospital mortality in critically ill patients compared with control subjects.