Acid-Suppressive Medication Use and the Risk for Hospital-Acquired Pneumonia
Acid-Suppressive Medication Use and the Risk for Hospital-Acquired Pneumonia
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DOI：
10.1001/jama.2009.722
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发表时间：
2009-05-27
影响因子：
120.7
通讯作者：
Marcantonio, Edward R.
中科院分区：
文献类型：
--
作者：
Herzig, Shoshana J.;Howell, Michael D.;Marcantonio, Edward R.
背景抑酸药物的使用一直在稳步增加，特别是在住院设置，尽管缺乏一个公认的适应症，在大多数patients.Objective检查抑酸药物和医院获得性pneumonia.Design，设置和患者之间的关联前瞻性药物流行病学队列研究。2004年1月至2007年12月期间在马萨诸塞州波士顿的大型城市学术医疗中心住院的所有患者;至少18岁;住院3天或3天以上的患者均符合入选条件。排除了在重症监护室度过的入院时间。抑酸药物使用定义为质子泵抑制剂或组胺（2）受体拮抗剂的任何顺序。传统的和倾向匹配的多变量logistic回归被用来控制confounders.Main结果测量医院获得性肺炎的发病率，通过从国际疾病分类，第九次修订，临床修改（JCD-9-CM）的代码定义，在患者暴露和未暴露于抑酸medication.Results的最终队列包括63 878入院。52%的住院患者使用抑酸药物，2219例住院患者（3.5%）发生医院获得性肺炎。抑酸药物暴露组的未校正医院获得性肺炎发生率高于未暴露组（4.9% vs 2.0%;比值比[OR]，2.6; 95%置信区间[CI]，2.3-2.8）。使用多变量logistic回归分析，抑酸药物暴露组中医院获得性肺炎的校正OR为1.3（95%CI，1.1-1.4）。匹配的倾向评分分析得出了相同的结果。质子泵抑制剂（OR，1.3; 95%CI，1.1-1.4）的相关性显著，但组胺2受体拮抗剂（OR，1.2; 95%CI，0.98-1.4）的相关性不显著。结论在这个大型的、以医院为基础的药物流行病学队列中，抑酸药物的使用与医院获得性肺炎的几率增加30%相关。在亚组分析中，仅质子泵抑制剂的使用显示了统计学显著性风险。JAMA. 2009;301（20）：2120-2128 www.jama.com
Context The use of acid-suppressive medication has been steadily increasing, particularly in the inpatient setting, despite lack of an accepted indication in the majority of these patients.Objective To examine the association between acid-suppressive medication and hospital-acquired pneumonia.Design, Setting, and Patients Prospective pharmacoepidemiologic cohort study. All patients who were admitted to a large, urban, academic medical center in Boston, Massachusetts, from January 2004 through December 2007; at least 18 years of age; and hospitalized for 3 or more days were eligible for inclusion. Admissions with time spent in the intensive care unit were excluded. Acid-suppressive medication use was defined as any order for a proton-pump inhibitor or histamine(2) receptor antagonist. Traditional and propensity-matched multivariable logistic regression were used to control for confounders.Main Outcome Measure Incidence of hospital-acquired pneumonia, defined via codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (JCD-9-CM), in patients exposed and unexposed to acid-suppressive medication.Results The final cohort comprised 63 878 admissions. Acid-suppressive medication was ordered in 52% of admissions and hospital-acquired pneumonia occurred in 2219 admissions (3.5%). The unadjusted incidence of hospital-acquired pneumonia was higher in the group exposed to acid-suppressive medication than in the unexposed group (4.9% vs 2.0%; odds ratio [OR], 2.6; 95% confidence interval [CI], 2.3-2.8). Using multivariable logistic regression, the adjusted OR of hospital-acquired pneumonia in the group exposed to acid-suppressive medication was 1.3 (95% CI, 1.1-1.4). The matched propensity-score analyses yielded identical results. The association was significant for proton-pump inhibitors (OR, 1.3; 95% CI, 1.1-1.4) but not for histamine2 receptor antagonists (OR, 1.2;95% CI, 0.98-1.4).Conclusions In this large, hospital-based pharmacoepidemiologic cohort, acid-suppressive medication use was associated with 30% increased odds of hospital-acquired pneumonia. In subset analyses, statistically significant risk was demonstrated only for proton-pump inhibitor use. JAMA. 2009;301(20):2120-2128 www.jama.com