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.
To determine the impact of using sucralfate versus H2RAs for SUP on patient important outcomes.



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.



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.



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.
Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, L8S 4K1, Canada.
Mustafa
M
Alquraini
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.
Fayez
F
Alshamsi
Department of Intensive Care 4131, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Morten Hylander
MH
Møller
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.
Emilie
E
Belley-Cote
Department of Neurosurgery, McMaster University, Hamilton, On L8l 2X2, Canada.
Saleh
S
Almenawer
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.
Roman
R
Jaeschke
Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO 80045, USA. Electronic address: Rob.MacLaren@ucdenver.edu.
Robert
R
MacLaren
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.
Waleed
W
Alhazzani
D000328:Adult; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D016638:Critical Illness; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006801:Humans; D011014:Pneumonia / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D013276:Stomach Ulcer / Q000517:prevention & control*; D013392:Sucralfate / Q000627:therapeutic use*
D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists; D013392:Sucralfate
Critical illness; Histamine-2-receptor antagonists; Meta-analysis; Stress ulcer; Sucralfate; Systematic review