Use of proton pump inhibitors is associated with increased mortality due to nosocomial pneumonia in bedridden patients receiving tube feeding

Aim

To investigate the association between the use of proton pump inhibitors (PPI) and nosocomial pneumonia and gastrointestinal bleeding in bedridden patients receiving tube feeding.

Methods

A total of 116 bedridden hospitalized patients receiving tube feeding, of which 80 were supported by percutaneous endoscopic gastrostomy and 36 by nasogastric tube, were included in the present study. The patients were divided into two groups: 62 patients treated with PPI (PPI group) and 54 patients without PPI (non‐PPI group). Mortality due to nosocomial pneumonia was evaluated using the Kaplan–Meier approach and the log–rank test.

Results

A total of 36 patients (31%) died of nosocomial pneumonia during the observation period; the mortality rate due to nosocomial pneumonia was significantly higher in the PPI group than in the non‐PPI group (P = 0.0395). Cox proportional hazard analysis showed that the use of PPI and lower levels of serum albumin were independent predictors of 2‐year mortality due to nosocomial pneumonia. Gastrointestinal bleeding was observed in four patients in the non‐PPI group (7.7%) and in one patient in the PPI group (1.6%); there was no significant difference between the two groups.

Conclusion

The use of PPI in bedridden tube‐fed patients was independently associated with mortality due to nosocomial pneumonia, and the PPI group had a non‐significant lower incidence of gastrointestinal bleeding than the non‐PPI group. Geriatr Gerontol Int 2018; 18: 1215–1218 .     

Severe systemic adverse reaction to proton pump inhibitors in an infant

Episodes of respiratory distress with chest retraction and wheezing, sometimes associated with facial edema, were noted after administering the proton pump inhibitors omeprazole and esomeprazole in an infant with gastroesophageal reflux. The disturbances relieved dramatically after withdrawing the proton pump inhibitor.     

质子泵抑制剂在老年心血管病中的应用

<正>质子泵抑制剂(proton pump inhibitors,PPIs)是心血管内科临床工作中常用的保护胃黏膜药物,但是有关PPIs在有心血管疾病特别是有冠状动脉疾病病史的患者群体中的安全性一直存在争议。最近一些年来,医务工作者对此问题非常关注,发表了一系列与之相关的专家共识和建议,本文对PPIs在老年心血管病中的应用做一简要回顾。1心血管病抗凝/抗栓治疗与消化道损伤     

质子泵抑制剂对冠状动脉介入术后患者氯吡格雷抵抗和再发心血管事件的影响

目的:探讨中国福建地区汉族患者择期经皮冠状动脉介入治疗(PCI)术后,质子泵抑制剂(PPI)对实验室氯吡格雷抵抗(LCR)的影响及与再发心血管事件(CVEs)之间的关系。方法:观察345例择期PCI术患者,收集患者服药前后最大血小板聚集率(MPA)和中位数为7个月随访期间CVEs再发的情况。结果:①氯吡格雷联合胃药组的MPA下降幅度明显低于未联合胃药组(P=0.009);氯吡格雷联合PPI组的MPA下降幅度明显低于未联合PPI组(P<0.01);进一步分析发现,氯吡格雷联合泮托拉唑组的MPA下降幅度明显高于奥美拉唑组和其他PPI组(P=0.004)。②服用胃药组的LCR和再发CVEs发生率明显高于未服用胃药组(38.5%∶23.3%,P=0.019;20.6%∶10.0%,P=0.039);服用PPI组的LCR和再发CVEs发生率明显高于未服用PPI组(48.4%∶27.6%,P<0.01;25.8%∶13.8%,P=0.001);奥美拉唑组的再发CVEs明显高于泮托拉唑组和其他PPI组(P=0.035);并且发现氯吡格雷联合奥美拉唑是PCI术后再发CVEs的独立危险因素(P=0.002,RR=3.486,95%CI=1.595～7.618)。结论:PCI术后服用PPI(尤其是奥美拉唑)时,可能会减弱氯吡格雷的疗效,增加心血管不良事件的风险。     

Obstructive sleep apnea is associated with interdialytic weight gain and increased long-term cardiovascular events in hemodialysis patients

Background

Obstructive sleep apnea (OSA) is common in hemodialysis (HD) patients. The reasons for the high prevalence and whether OSA is associated with vascular impairment, end-organ damage, and prognosis are not completely clear.

Methods

We evaluated patients with low cardiovascular risk on HD, not treated by CPAP. Laboratory tests, sleep questionnaires (Berlin and Epworth) and polysonography studies, echocardiography, and markers of arterial stiffness and atherosclerosis were performed. After the initial evaluation, patients were followed up until cardiovascular events, renal transplantation, or death.

Results

Fifty-five patients (49% male, 50?±?9 years, body mass index 24.7?±?4.5 kg/m²) were included. OSA (apnea-hypopnea index ≥?5 events/h) occurred in 73% of the patients. The proportion of patients with interdialytic weight gain >?2 kg was higher in patients with OSA than those without OSA (96 vs. 55%; p?=?0.002). Left ventricular (LV) posterior wall thickness (10.0?±?1.9 vs. 11.3?±?1.8 mm; p?=?0.04) and LV diastolic diameter (48?±?5 vs. 53?±?5 mm; p?=?0.003) were higher in patients with OSA than in patients without OSA, respectively. Sleep questionnaires did not predict OSA. No significant differences were found in pulse wave velocity, carotid intima-media thickness, and ankle-brachial index between the groups. Multivariate analysis showed that interdialytic weight gain >?2 kg and LV diastolic diameter were independently associated with OSA. On follow-up (median 45 months), OSA was found to be associated with a higher incidence of cardiovascular (CV) events (28 vs. 7%, log-rank?=?0.042).

Conclusions

OSA was associated with increased risk of CV events. Significant (>?2 kg) interdialytic weight gain was independently associated with OSA.

     

Watching soccer is not associated with an increase in cardiac events

Background

It remains controversial, whether spectators of soccer matches are exposed to an increased risk of cardiac events. In 2006, the Soccer World Cup (SWC) took place in Germany and provided an excellent opportunity to assess the effects of emotional stress on cardiac events in a large cohort of soccer enthusiasts in the region of Bavaria.

Methods

We analyzed data from the Bavarian Council for Statistics and Data Management for the period of SWC (June 9–July 9, 2006) and reference periods (SWCRef; May 1–July 31, 2005; May 1–June 8, 2006 and July 10–31, 2006) for the following diagnoses: myocardial infarction; myocardial re-infarction; cardiac arrest; paroxysmal tachycardia; atrial fibrillation, atrial flutter; all remaining tachyarrhythmias. Data were compared to the seven days during the tournament, on which the German team played (SWCGerman), the rest of the SWC period (i.e. the days the German team did not play, 24 days, SWCRest) and SWCRef (61 days).

Results

There was neither a significant increase (p > 0.433) in total cardiac events in Bavaria per day during SWCGerman (161.1 ± 46.7) or SWCRest (170.5 ± 52.3) as compared to the SWCRef (176.2 ± 51.8), nor in any investigated diagnosis. After controlling for age, gender, loss of a match, outside temperature and nitric-dioxide air pollution levels the results remained essentially unchanged.

Conclusion

Watching soccer was not associated with an increased incidence of cardiac events, regardless of whether the home team played or not. These data further support the hypothesis that spectators of sporting events are not exposed to an increased risk of cardiac events.     

质子泵抑制剂联合氯吡格雷在心血管疾病治疗中的研究进展

抗血小板药物可有效减少血栓事件的发生,但增加胃肠道出血风险,通常加用质子泵抑制剂(PPI)来避免抗血小板药物所导致的黏膜损害。PPI具有与氯吡格雷相同的肝脏的代谢途径,可能降低氯吡格雷的抗血小板疗效并导致发生不良心血管事件的危险增加。氯吡格雷与PPI联合应用是否影响抗血小板药物治疗效果,目前对这一现象尚无定论,该文就氯吡格雷与PPI相互作用的机制和临床研究进展作一综述。     

Red blood cell distribution width is associated with adverse cardiovascular events after septal myectomy

BackgroundRed blood cell distribution width (RDW) is associated with increased morbidity and mortality in several cardiovascular diseases. However, the prognostic significance of RDW in patients with hypertrophic obstructive cardiomyopathy (HOCM) who underwent septal myectomy remains unclear as no studies have been conducted on this topic. This study aimed to assess the prognostic significance of RDW in these patients.MethodsA total of 867 adults with HOCM who underwent septal myectomy at Fuwai Hospital from 2011 to 2017 were retrospectively studied. All patients were assessed comprehensively, including their medical history, echocardiograms, and blood test results.ResultsThe median age of patients was 47.9 [interquartile range (IQR), 37.0–56.0] years and 61.5% of patients were men. During a median follow-up period of 32 (IQR, 17–53) months, 26 patients died and 23 had a cardiovascular death during follow-up. Compared to patients in the lowest RDW quartile, those in the highest quartile had a significantly lower 5-year survival free from all-cause and cardiovascular death (95.9% vs. 87.6%, P<0.001; 95.9% vs. 89.9%, P<0.001). Compared with lower RDW, higher RDW was significantly associated with all-cause and cardiovascular death after adjustment for age, sex, body mass index, and relevant clinical risk factors [per RDW standard deviation (SD) hazard ratio (HR) increase =1.76, 95% confidence interval (CI): 1.54–2.05, P<0.001; per RDW SD HR =1.91, 95% CI: 1.63–2.22, P for trend <0.001].ConclusionsHigher RDW is independently associated with all-cause and cardiovascular death in patients with HOCM after septal myectomy. Therefore, this readily available biomarker could be considered as an additive biomarker for risk stratification in these patients.     

Effect of individual proton pump inhibitors on cardiovascular events in patients treated with clopidogrel following coronary stenting:: Results From the Ibaraki Cardiac Assessment Study Registry

Objectives : The aim of this study was to evaluate whether combination therapy of clopidogrel and proton pump inhibitors (PPIs) causes higher numbers of cardiovascular events than clopidogrel alone in Japanese patients. Background : PPIs are often prescribed in combination with clopidogrel following coronary stenting. PPIs are reported to diminish the effect of clopidogrel because both are metabolized by CYP2C19. However, no reports address the effects of PPIs on cardiovascular events following coronary stenting in the Japanese population. Methods : A total of 1,887 patients treated with clopidogrel following coronary stenting were enrolled in the Ibaraki Cardiac Assessment Study (ICAS) registry. All subjects were classified into two groups according to treatment without (n = 819) or with (n = 1,068) PPI. Propensity score analysis matched 1:1 according to treatment without PPI (n = 500) or with PPI (n = 500). Primary endpoint was the composite of all‐cause death or myocardial infarction. Results : No significant difference was observed in the primary endpoint between the group without PPI and the group with PPI (4.6% vs. 4.6%, P = 0.77). In contrast, a significant difference was found between the group without PPI and with PPI in regard to the incidence of gastrointestinal bleeding at the end of the follow‐up period and the specific PPI prescribed (2.4% vs. 0.8%, adjusted HR = 0.30, 95% Confidence interval 0.08‐0.87, P = 0.026) after propensity score matching. Conclusions : No significant association between PPI use and primary endpoint was observed in the Japanese population, whereas PPI use resulted in a significant reduction in the rate of gastrointestinal bleeding. © 2012 Wiley Periodicals, Inc.     

High pulse pressure associated with cardiovascular events in patients with type 2 diabetes undergoing hemodialysis

BACKGROUND: The aims of this study were to examine systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and pulse pressure (PP) in patients with type 2 diabetes undergoing hemodialysis (HD), and to assess the relationships between these parameters and cardiovascular (CV) events such as coronary heart disease and congestive cardiac failure. METHODS: A total of 80 Afro-Caribbean type 2 diabetic patients undergoing hemodialysis in three centers in Guadeloupe, French West Indies, were included in this cross-sectional study. Pre- and postdialysis BP were recorded. Logistic regression methods and areas under the receiver operating characteristic curves were used. RESULTS: The mean age (+/- standard deviation) was 62.2 years (+/-10.2 years). A total of 24 subjects (30%) had one or more CV events. Sixteen (20%) had coronary disease, 15 (18.8%) cardiac failure, and seven (8.8%) had both. The medians [interquartile ranges] for predialysis PP was higher in patients with CV comorbidity than in patients without a history of CV at 84.5 mm Hg [74.5 to 92.3]v 69.5 mm Hg [61.0 to 79.5], P = .003. Areas under the ROC curves (95% confidence intervals) predialysis were significant only for SBP and PP at 0.70 (0.58 to 0.82) v 0.71 (0.59 to 0.83) without statistical differences. After adjustment for gender, age, body mass index, antihypertensive use, time on hemodialysis (>or=2 years), and hemoglobin rate, the odds ratio was significant only predialysis, and a higher odds ratio was found for PP at 2.25 (1.22 to 4.18), P = .01, than for SBP 1.97 (1.12 to 3.49), P = .02. CONCLUSIONS: Our results suggest that the strongest association of PP with CV morbidities should be considered in therapeutic strategies. These results show the necessity of targeting antihypertensive treatment to patients' predialysis blood pressure values.     

Serum creatinine to cystatin C ratio is associated with major adverse cardiovascular events in patients with obstructive coronary artery disease

Background & aimsSarcopenia is a clinical syndrome that features muscle atrophy and weakness, and has been associated with cardiovascular events and poor clinical outcomes. Recently, the sarcopenia index (SI) was developed as a simple screening tool based upon the serum creatinine to cystatin C (CysC) ratio. We investigated the association between SI and the prevalence of major adverse cardiovascular events (MACE) in patients with obstructive CAD.Methods & ResultsBetween January 2010 and December 2018, patients with angina pectoris and obstructive CAD requiring coronary artery intervention were enrolled. Serum levels of CysC and other biomarkers were assessed. Patients were divided into two groups according to the SI ([Cr/CysC] x 100). Demographic characteristics and clinical outcomes of the two groups were evaluated. A total of 427 patients (79.6% men, mean age 69.55 ± 12.04 years) were enrolled. Patients with SI < 120 (n = 214, 28%) were older, more likely to be of the female gender, and to have more hypertension and congestive heart failure (all p < 0.05). The prevalence of major adverse cardiovascular events (MACE) composed of myocardial infarction, stroke, and all-cause mortality was higher in patients with lower SI (p = 0.026). After adjusting for potential confounding factors, multivariate Cox regression (hazard ratio 2.08, p = 0.045) and Kaplan–Meier analyses (log-rank p = 0.0371) revealed that lower SI was significantly associated with a higher prevalence of MACE.ConclusionsSerum creatinine to cystatin C ratio (SI) may be a useful surrogate marker to predict the future prevalence of MACE in patients with obstructive CAD.