title: [Relationship between antacid therapy and hospital acquired pneumonia in critically ill patients: a meta-analysis].
abstract: OBJECTIVE
  To systematically review the effect of antacid medication on stress-related mucosal disease (SRMD) bleeding, hospital acquired pneumonia (HAP), and hospital mortality in critically ill patients admitted to intensive care unit (ICU).
  
  
  METHODS
  Related articles were retrieved from Medline Database (from January 1980 to December 2012). Randomized control trials (RCTs) focused on comparison between antacid and sucralfate were collected, and then a meta-analysis was performed.
  
  
  RESULTS
  Twelve studies including a total of 2537 patients admitted to ICU were qualified for analysis. Antacid medication significantly increased the incidence of HAP when compared with sucralfate in 11 trials [19.36% (249/1286) vs. 15.23% (184/1208), odds ratio (OR)=1.27, 95% confidence interval (95%CI): 1.03-1.57, P=0.02]. Subgroup analyses showed that antacid therapy significantly reduce the incidence of clinically significant bleeding compared with sucralfate [1.80% (12/667) vs. 3.86% (26/673), OR=0.46, 95%CI: 0.23-0.91, P=0.03], however, it did not lower the incidence of overt bleeding [7.09% (40/564) vs. 7.35% (36/490), OR=1.00, 95%CI: 0.62-1.62, P=0.99]. There was no significant difference between antacid group and sucralfate group on neither ICU mortality nor hospitalization mortality in 11 studies [25.58% (288/1126) vs. 23.65% (268/1133), OR=1.11, 95%CI: 0.92-1.35, P=0.28].
  
  
  CONCLUSIONS
  Antacid therapy used in critically ill patients may increase the incidence of HAP while reduce the rate of upper gastrointestinal bleeding, while it exerts no influence on mortality rate when compared with sucralfate treatment in this meta-analysis. It is imperative to restrict the overuse of such medication, and further RCTs focused on indication and withdrawal should be encouraged.
authors.affiliation: Neurological Intensive Care Unit, the Affiliated Hospital of Medical College, Qingdao University, Shandong, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Shan
authors.forename: Xiu
authors.initials: X
authors.lastname: Li
authors.forename: Ke
authors.initials: K
authors.lastname: Liu
authors.forename: Mei-na
authors.initials: MN
authors.lastname: Sun
authors.forename: Zhi-xin
authors.initials: ZX
authors.lastname: Yao
authors.forename: Lian-di
authors.initials: LD
authors.lastname: Li
mesh_terms: D000863:Antacids / Q000009:adverse effects* / Q000627:therapeutic use; D016638:Critical Illness; D003428:Cross Infection / Q000139:chemically induced; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D011014:Pneumonia / Q000139:chemically induced*; D016032:Randomized Controlled Trials as Topic; D013392:Sucralfate / Q000627:therapeutic use
chemical_list: D000863:Antacids; D013392:Sucralfate