The Association Between Proton Pump Inhibitor Use and Outcome After Aneurysmal Subarachnoid Hemorrhage

• Published in: Neurocritical care Vol. 15; no. 3; pp. 393 - 399
• Main Authors: Fletcher, Jeffrey J., Brown, Devin L., Rajajee, Venkatakrishna, Jacobs, Teresa L., Rochlen, Lauryn, Meurer, William
• Format: Journal Article
• Language: English
• Published: New York Humana Press Inc 01.12.2011; Springer Nature B.V
• Subjects: Acids; Adult; Aged; Aneurysms; Brain Damage, Chronic - diagnosis; Brain Damage, Chronic - prevention & control; Cerebral Infarction - diagnosis; Cerebral Infarction - prevention & control; Cohort analysis; Cohort Studies; Combined Modality Therapy; Critical Care Medicine; Female; Hemodynamics; Hemorrhage; Histamine; Histamine H2 Antagonists - adverse effects; Histamine H2 Antagonists - therapeutic use; Humans; Hypertension; Hypotheses; Indexing in process; Intensive; Internal Medicine; Logistic Models; Male; Medical imaging; Medical records; Medicine; Medicine & Public Health; Middle Aged; Multivariate Analysis; Neurologic Examination - drug effects; Neurology; Odds Ratio; Original Article; Proton Pump Inhibitors - adverse effects; Proton Pump Inhibitors - therapeutic use; Retrospective Studies; Standard of care; Statistical analysis; Stroke; Subarachnoid Hemorrhage - diagnosis; Subarachnoid Hemorrhage - drug therapy; Subarachnoid Hemorrhage - physiopathology; Treatment Outcome; White people; Delayed neurological deficits; Subarachnoid hemorrhage; Acid suppression therapy; Delayed ischemic neurological deficits; Cerebral vasospasm; Proton pump inhibitors; Delayed infarction
• ISSN: 1541-6933; 1556-0961
• DOI: 10.1007/s12028-011-9532-9

Background For many patients with aneurysmal subarachnoid hemorrhage (SAH), initiation of acid suppression therapy is concordant with guidelines and has become standard of care in neurological intensive care units. The aim of this study was to evaluate the association between type of acid suppression therapy and outcome following aneurysmal SAH. Methods Retrospective cohort study of consecutive aneurysmal SAH patients identified over a 5 year period. Of 297 patients identified, 148 met inclusion criteria for analysis. Multivariable logistic regression was performed to evaluate the independent association between type of acid suppression therapy (proton pump inhibitor (PPI) vs histamine 2 receptor antagonist (H2A)) and the outcomes of delayed neurological deficits (DNDs), delayed infarction and favorable functional outcome defined as a modified Rankin Scale ≤ 2. Results Forty-two patients were treated with a PPI and 106 with a H2A. Baseline characteristics were well-matched between groups with the exception of year of treatment and prophylactic antiepileptic medication. Patients placed on a PPI were less likely to have a favorable functional outcome than those on a H2A (45 vs 64%; P  = 0.035). In adjusted analysis, no association was identified between PPI use and DNDs (OR 1.18 (95% confidence interval: 0.48–2.88)) or delayed infarction (OR 1.64 (0.64–4.16)); however, PPI use was associated with a lower odds of favorable functional outcome (OR 0.37 (0.16–0.85)). Conclusions Type of acid suppression therapy was not associated with DNDs or delayed infarction following aneurysmal SAH. However, PPI use was associated with poorer functional outcome. Further study of acid suppression therapy and PPI use following SAH is warranted.