title: Risk of Stroke-Associated Pneumonia With Acid-Suppressive Drugs: A Population-Based Cohort Study.
abstract: Acid-suppressive drugs, including histamine-2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs), are common medications used for treating upper gastrointestinal tract disorders. However, acid-suppressive drugs have been reported to increase the risk of pneumonia in numerous disease populations. However, the relationship between acid-suppressive drugs and stroke-associated pneumonia (SAP) remains controversial. The purpose of this study was to investigate the association between acid-suppressive drug usage and pneumonia among patients with stroke by using a nationwide data set. A population-based cohort study was conducted using a data set from the Taiwanese National Health Insurance Research Database. Data on patients with new-onset stroke from 2010 to 2011 were collected. Patients with and without acid-suppressive drug usage were followed up to identify the occurrence of any type of pneumonia. We estimated the adjusted hazard ratios (HRs) by using the Cox proportional hazards model. The study cohort comprised 7965 patients with new-onset stroke. The incidence of pneumonia was 6.9% (552/7965) and more than 40% (225/552) of patients developed pneumonia within 3 months after an acute stroke. Acid-suppressive drug usage was an independent risk factor of pneumonia. The adjusted HR for the risk of pneumonia in patients with new-onset stroke using acid-suppressive drugs was 1.44 (95% confidence interval [CI] = 1.18-1.75, P < 0.01). Only PPI usage increased risk of chronic SAP (adjusted HR = 1.46, 95% CI = 1.04-2.05). Acid-suppressive drug usage was associated with a slightly increased risk of SAP. Physicians should exercise caution when prescribing acid-suppressive drugs to patients with stroke, particularly at the chronic stage.
authors.affiliation: From the Department of Emergency Medicine, School of Medicine, Chung Shan Medical University (S-WH, C-BY); Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung (S-WH, C-BY); Cancer Research Center, Changhua Christian Hospital, Changhua (M-JH); Institute of Medicine, Chung Shan Medical University (M-JH, S-FY); Department of Medical Research, Chung Shan Medical University Hospital (SF-Y, Y-HW); School of Dentistry, Chung Shan Medical University (Y-TY); Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan (Y-TY).
authors.forename: Sai-Wai
authors.initials: SW
authors.lastname: Ho
authors.forename: Ming-Ju
authors.initials: MJ
authors.lastname: Hsieh
authors.forename: Shun-Fa
authors.initials: SF
authors.lastname: Yang
authors.forename: Ying-Tung
authors.initials: YT
authors.lastname: Yeh
authors.forename: Yu-Hsun
authors.initials: YH
authors.lastname: Wang
authors.forename: Chao-Bin
authors.initials: CB
authors.lastname: Yeh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006635:Histamine H2 Antagonists / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology*; D016016:Proportional Hazards Models; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D020521:Stroke / Q000150:complications*; D013624:Taiwan; D013997:Time Factors; D055815:Young Adult
chemical_list: D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors