Sucralfate versus histamine 2 receptor antagonists for stress ulcer prophylaxis in adult critically ill patients: A meta-analysis and trial sequential analysis of randomized trials

TY - JOUR

T1 - Sucralfate versus histamine 2 receptor antagonists for stress ulcer prophylaxis in adult critically ill patients

T2 - A meta-analysis and trial sequential analysis of randomized trials

AU - Alquraini, Mustafa

AU - Alshamsi, Fayez

AU - Møller, Morten Hylander

AU - Belley-Cote, Emilie

AU - Almenawer, Saleh

AU - Jaeschke, Roman

AU - MacLaren, Robert

AU - Alhazzani, Waleed

PY - 2017/8

Y1 - 2017/8

N2 - Purpose To determine the impact of using sucralfate versus H2RAs for SUP on patient important outcomes. Materials and methods We searched CENTRAL, MEDLINE, EMBASE, ACPJC, clinical trials registries, and conference proceedings through June 2016 for randomized controlled trials (RCTs) comparing sucralfate to H2RAs for SUP in adult critically ill patients. Results 21 RCTs enrolling 3121 patients met inclusion criteria. There was no significant difference between sucralfate compared to H2RAs in the risk of clinically important GI bleeding (risk ratio [RR] 1.19; 95% CI [confidence interval] 0.79, 1.80; P = 0.42; I2 = 0%; low quality evidence). However, there was a statistically significant lower risk of ICU acquired pneumonia with sucralfate compared to H2RAs (RR 0.84; 95% CI 0.72, 0.98; P = 0.03; I2 = 0%; moderate quality evidence). Sucralfate did not significantly affect the risk of death (RR 0.95; 95% CI 0.82, 1.10; P = 0.51; I2 = 0%; high quality evidence), or duration of ICU stay in days (mean difference − 0.39; 95% CI [− 1.12, 0.34]; P = 0.29; I2 = 0%; moderate quality evidence). Trial sequential analysis adjusted estimates were consistent with conventional estimates. Conclusion Moderate quality evidence suggests that sucralfate reduced ICU acquired pneumonia compared to H2RAs in adult critically ill patients, with no significant impact on GI bleeding or death.

AB - Purpose To determine the impact of using sucralfate versus H2RAs for SUP on patient important outcomes. Materials and methods We searched CENTRAL, MEDLINE, EMBASE, ACPJC, clinical trials registries, and conference proceedings through June 2016 for randomized controlled trials (RCTs) comparing sucralfate to H2RAs for SUP in adult critically ill patients. Results 21 RCTs enrolling 3121 patients met inclusion criteria. There was no significant difference between sucralfate compared to H2RAs in the risk of clinically important GI bleeding (risk ratio [RR] 1.19; 95% CI [confidence interval] 0.79, 1.80; P = 0.42; I2 = 0%; low quality evidence). However, there was a statistically significant lower risk of ICU acquired pneumonia with sucralfate compared to H2RAs (RR 0.84; 95% CI 0.72, 0.98; P = 0.03; I2 = 0%; moderate quality evidence). Sucralfate did not significantly affect the risk of death (RR 0.95; 95% CI 0.82, 1.10; P = 0.51; I2 = 0%; high quality evidence), or duration of ICU stay in days (mean difference − 0.39; 95% CI [− 1.12, 0.34]; P = 0.29; I2 = 0%; moderate quality evidence). Trial sequential analysis adjusted estimates were consistent with conventional estimates. Conclusion Moderate quality evidence suggests that sucralfate reduced ICU acquired pneumonia compared to H2RAs in adult critically ill patients, with no significant impact on GI bleeding or death.

KW - Critical illness

KW - Histamine-2-receptor antagonists

KW - Meta-analysis

KW - Stress ulcer

KW - Sucralfate

KW - Systematic review

U2 - 10.1016/j.jcrc.2017.03.005

DO - 10.1016/j.jcrc.2017.03.005

M3 - Journal article

C2 - 28315586

AN - SCOPUS:85020729889

SN - 0883-9441

VL - 40

SP - 21

EP - 30

JO - Journal of Critical Care

JF - Journal of Critical Care

ER -