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

Mustafa Alquraini; Fayez Alshamsi; Morten Hylander Møller; Emilie Belley-Cote; Saleh Almenawer; Roman Jaeschke; Robert MacLaren; Waleed Alhazzani

doi:10.1016/j.jcrc.2017.03.005

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

J Crit Care. 2017 Aug:40:21-30. doi: 10.1016/j.jcrc.2017.03.005. Epub 2017 Mar 8.

Authors

Mustafa Alquraini¹, Fayez Alshamsi², Morten Hylander Møller³, Emilie Belley-Cote⁴, Saleh Almenawer⁵, Roman Jaeschke⁶, Robert MacLaren⁷, Waleed Alhazzani⁸

Affiliations

¹ Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, L8S 4K1, Canada.
² Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, L8S 4K1, Canada; Department of Internal Medicine, College of Medicine & Health Sciences, UAE University, PO Box 17666, United Arab Emirates. Electronic address: fayez.alshamsi@medportal.ca.
³ Department of Intensive Care 4131, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
⁴ Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, L8S 4K1, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, L8S 4K1, Canada. Electronic address: emilie.belley-cote@medportal.ca.
⁵ Department of Neurosurgery, McMaster University, Hamilton, On L8l 2X2, Canada.
⁶ Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, L8S 4K1, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, L8S 4K1, Canada. Electronic address: jaeschke@mcmaster.ca.
⁷ Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO 80045, USA. Electronic address: Rob.MacLaren@ucdenver.edu.
⁸ Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, L8S 4K1, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, L8S 4K1, Canada. Electronic address: alhazzaw@mcmaster.ca.

PMID: 28315586
DOI: 10.1016/j.jcrc.2017.03.005

Abstract

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.

Keywords: Critical illness; Histamine-2-receptor antagonists; Meta-analysis; Stress ulcer; Sucralfate; Systematic review.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Adult
Anti-Ulcer Agents / therapeutic use*
Critical Illness*
Histamine H2 Antagonists / therapeutic use*
Humans
Pneumonia / prevention & control*
Randomized Controlled Trials as Topic
Stomach Ulcer / prevention & control*
Sucralfate / therapeutic use*

Substances

Anti-Ulcer Agents
Histamine H2 Antagonists
Sucralfate