质子泵抑制剂与组胺-2 受体拮抗剂对脓毒症高危患者急性肾损伤的影响

IF 2.9 3区 医学 Q2 PHARMACOLOGY & PHARMACY
Pharmacotherapy Pub Date : 2024-07-01 Epub Date: 2024-06-20 DOI:10.1002/phar.2947
Hua-Ping Fan, Yu Zhou, Mei-Li Chen, Kun-Hua Qiu, Xue Feng, Chao Zhou, Min-Li Zhu, Rong-Zhong Huang, Tian-Yang Hu
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引用次数: 0

摘要

背景:比较质子泵抑制剂(PPI)和组胺-2受体拮抗剂(H2RA)的使用对脓毒症高危患者发生应激性溃疡的急性肾损伤(AKI)的影响:使用重症监护医学信息中心 IV 2.2 版数据库,纳入了具有应激性溃疡高危因素(即休克、凝血功能障碍、有创机械通气或慢性肝病)的脓毒症患者。暴露包括重症监护病房(ICU)入院后 24 小时内或入院前的 PPIs 和 H2RAs。主要终点是肾病改善全球预后标准第三阶段(KDIGO-3)定义的严重脓毒症相关性 AKI。为平衡基线特征,进行了倾向评分匹配(PSM)。采用多变量考克斯比例危险回归估计效应大小:结果:共纳入 4731 名 PPI 使用者和 4903 名 H2RA 使用者。在 PSM 之后,共有 1785 对人暴露于 PPIs 和 H2RAs。在 PSM 队列中,PPI 组的 KDIGO-3 累计发病率高于 H2RA 组(对数秩检验,P = 0.009)。回归分析表明,与使用 H2RA 相比,PPI 暴露[调整后危险比 1.32,95% 置信区间 (CI) 1.11-1.58,p = 0.002]与 KDIGO-3 事件相关。这种关联在敏感性分析中保持一致。此外,与 H2RA 组相比,PPI 组对肾脏替代治疗的需求更高(3.6% 对 2.1%,P = 0.012):结论:在高风险应激性溃疡脓毒症患者中,与使用 H2RA 相比,接触 PPI 与发生 KDIGO-3 AKI 相关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Effect of proton pump inhibitors versus histamine-2 receptor antagonists on acute kidney injury in septic patients at high risk for developing stress ulcers.

Background: To compare the effects of proton pump inhibitor (PPI) and histamine-2 receptor antagonist (H2RA) use on the occurrence of acute kidney injury (AKI) in septic patients at high risk for developing stress ulcers.

Methods: Using the Medical Information Mart for Intensive Care IV version 2.2 database, septic patients with high-risk factors for stress ulcers (i.e., shock, coagulopathy, invasive mechanical ventilation, or chronic liver diseases) were included. Exposures included PPIs and H2RAs within 24 h of intensive care unit (ICU) admission or prior to ICU admission. The primary end point was severe sepsis-associated AKI as defined by the Kidney Disease Improving Global Outcomes criteria stage 3 (KDIGO-3). Propensity score matching (PSM) was performed to balance baseline characteristics. Multivariable Cox proportional hazards regression was used to estimate the effect size.

Results: 4731 PPI users and 4903 H2RA users were included. After PSM, there were 1785 pairs exposed to PPIs and H2RAs. In the PSM cohort, the cumulative incident KDIGO-3 rate was higher in the PPI group than in the H2RA group (log-rank test, p = 0.009). Regression analyses showed that PPI exposure [adjusted hazard ratio 1.32, 95% confidence interval (CI) 1.11-1.58, p = 0.002] was associated with incident KDIGO-3 compared with H2RA use. This association remained consistent in sensitivity analyses. Additionally, the PPI group had a higher need for kidney replacement therapy compared with the H2RA group (3.6% vs. 2.1%, P = 0.012).

Conclusions: Among septic patients at high risk for developing stress ulcers, PPI exposure was associated with incident KDIGO-3 AKI compared with H2RA use.

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来源期刊
Pharmacotherapy
Pharmacotherapy 医学-药学
CiteScore
7.80
自引率
2.40%
发文量
93
审稿时长
4-8 weeks
期刊介绍: Pharmacotherapy is devoted to publication of original research articles on all aspects of human pharmacology and review articles on drugs and drug therapy. The Editors and Editorial Board invite original research reports on pharmacokinetic, bioavailability, and drug interaction studies, clinical trials, investigations of specific pharmacological properties of drugs, and related topics.
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