In this episode, I’ll discuss the effect of unnecessary long-term continuation of newly initiated stress ulcer prophylaxis in the ICU on morbidity and mortality after hospital discharge.
ICU patients are routinely started on proton pump inhibitor therapy for the purpose of stress ulcer prophylaxis. However, PPI use often continues after ICU and hospital discharge without indication. To determine whether such unnecessary continuation of PPIs affects morbidity and mortality, a group of authors published a retrospective cohort study recently in Critical Care Medicine.
Over 11,000 patients were analyzed from a German insurance database of patient data. The total cohort was ICU patients who received PPI therapy for the first time during their index ICU stay without having an indication for its continuation. Patients were then stratified into two groups: 1) patients without further PPI therapy and 2) patients with continuation of PPI therapy beyond eight weeks after hospital discharge.
In addition to known adverse effects of PPIs, the authors also examined the 1-year rehospitalization rate and 2-year mortality rate for the cohort.
Over 40% of patients continued a PPI without an indication. The rate of pneumonia was 27% greater in these patients, and they had a 34% greater risk of rehospitalization at one year. 2-year mortality risk was also 17% greater in patients who continued a PPI without an indication. All of these differences reached statistical significance.
The authors concluded:
These data demonstrate that an unnecessary continuation of PPI therapy after hospital discharge may significantly impact morbidity and mortality. To avoid potentially harmful overuse of a PPIs, intensivists should ensure timely cessation of a temporarily indicated PPI therapy.
While this is a retrospective study that cannot prove causation, the potential exists to positively impact clinically meaningful outcomes such as rehospitalization and mortality with the simple intervention of PPI discontinuation when there is no indication after ICU discharge.
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