Risk of Community-Acquired Pneumonia with Outpatient Proton-Pump Inhibitor Therapy: A Systematic Review and Meta-Analysis
Risk of Community-Acquired Pneumonia with Outpatient Proton-Pump Inhibitor Therapy: A Systematic Review and Meta-Analysis
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DOI：
10.1371/journal.pone.0128004
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发表时间：
2015-06-04
期刊：
影响因子：
3.7
通讯作者：
Crowell, Trevor A.
中科院分区：
文献类型：
--
作者：
Lambert, Allison A.;Lam, Jennifer O.;Crowell, Trevor A.
质子泵抑制剂（PPIs）是最常用的处方药之一。社区获得性肺炎（CAP）是发病率、死亡率和医疗支出的常见原因。一些研究表明，PPI使用者患CAP的风险增加。我们进行了系统回顾和荟萃分析，以确定门诊PPI治疗与成人CAP风险之间的关系。方法于2014年2月3日系统检索MEDLINE、EMBASE、CINAHL、Cochrane Central Register of Controlled Trials、Scopus和Web of Science。病例对照研究、病例交叉研究、队列研究和随机对照试验均报告了bb0 = 18岁患者门诊PPI暴露和CAP诊断。我们的主要结局是CAP和PPI治疗之间的关联。次要结果检查了CAP住院的风险，亚组分析评估了不同年龄组、不同PPI剂量和不同PPI治疗持续时间的患者中PPI使用与CAP之间的关系。结果对33项研究进行了系统回顾，其中26项研究纳入meta分析。这26项研究包括6351656名参与者中的226769例CAP。我们观察到CAP与动态PPI治疗的总风险为1.49 （95% CI 1.16, 1.92; I2 99.2%）。这种风险在治疗的第一个月增加（OR 2.10; 95% CI 1.39, 3.16），与PPI剂量或患者年龄无关。PPI治疗也增加了CAP住院的风险（OR: 1.61; 95% CI: 1.12, 2.31）。门诊使用PPI与CAP风险增加1.5倍相关，在开始治疗后的前30天内风险最高。提供者在考虑使用PPI时应该意识到这种风险，特别是在可能有替代方案或使用PPI的益处不确定的情况下。
BackgroundProton-pump inhibitors (PPIs) are among the most frequently prescribed medications. Community-acquired pneumonia (CAP) is a common cause of morbidity, mortality and healthcare spending. Some studies suggest an increased risk of CAP among PPI users. We conducted a systematic review and meta-analysis to determine the association between outpatient PPI therapy and risk of CAP in adults.MethodsWe conducted systematic searches of MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, Scopus and Web of Science on February 3, 2014. Case-control studies, case-crossover, cohort studies and randomized controlled trials reporting outpatient PPI exposure and CAP diagnosis for patients >= 18 years old were eligible. Our primary outcome was the association between CAP and PPI therapy. A secondary outcome examined the risk of hospitalization for CAP and subgroup analyses evaluated the association between PPI use and CAP among patients of different age groups, by different PPI doses, and by different durations of PPI therapy.ResultsSystematic review of 33 studies was performed, of which 26 studies were included in the meta-analysis. These 26 studies included 226,769 cases of CAP among 6,351,656 participants. We observed a pooled risk of CAP with ambulatory PPI therapy of 1.49 (95% CI 1.16, 1.92; I2 99.2%). This risk was increased during the first month of therapy (OR 2.10; 95% CI 1.39, 3.16), regardless of PPI dose or patient age. PPI therapy also increased risk for hospitalization for CAP (OR 1.61; 95% CI: 1.12, 2.31).DiscussionOutpatient PPI use is associated with a 1.5-fold increased risk of CAP, with the highest risk within the first 30 days after initiation of therapy. Providers should be aware of this risk when considering PPI use, especially in cases where alternative regimens may be available or the benefits of PPI use are uncertain.