Sucralfate Compared to Histamine 2 Receptor Antagonists for Stress Ulcer Prophylaxis in the Intensive Care Unit: A Systematic Review and Meta-analysis of Randomized Trials
CCCF ePoster library. Alshamsi F. Nov 2, 2016; 151000; 118
Dr. Fayez Alshamsi
Dr. Fayez Alshamsi
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Topic: Systematic Review, Meta-analysis, or Meta-synthesis

Sucralfate Compared to Histamine 2 Receptor Antagonists for Stress Ulcer Prophylaxis in the Intensive Care Unit: A Systematic Review and Meta-analysis of Randomized Trials

Alshamsi Fayez1,2, Alquraini Mustafa1,3, Bellay-Cote Emilie3, Almenawer Saleh4, Alhazzani Waleed1,3.
1 Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Canada.
2 Department of Internal Medicine, College of Medicine & Health Sciences, UAE University, Al Ain, UAE.
3 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
4 Department of Neurosurgery, McMaster University, Hamilton, Canada.


Background: Histamine-2-receptor antagonists (H2RAs) are more commonly used than sucralfate for stress ulcer prophylaxis (SUP) in the intensive care unit (ICU). However, the relative efficacy and safety of sucralfate compared to H2RAs for SUP needs to be determined.
Objectives: We performed a systematic review and meta-analysis of randomized trials to determine the impact of using sucralfate versus H2RAs, for SUP in adult critically ill patients, on gastrointestinal (GI) bleeding and pneumonia outcomes.
Methods: We searched CENTRAL, MEDLINE, EMBASE, ACPJC, clinical trials registries, and conference proceedings through June 2016. We included randomized controlled trials (RCTs) comparing sucralfate to H2RAs for SUP in adult critically ill patients, that reported on GI bleeding, ICU acquired pneumonia, Clostridium difficile infection, ICU length of stay, or mortality. Two reviewers, independently and in duplicate, screened potentially relevant references, assessed study reports for eligibility, evaluated risk of bias and performed data extraction. We assessed the quality of evidence using  the GRADE approach. Main outcomes were clinically important GI bleeding, overt GI bleeding, ICU acquired pneumonia, mortality, Clostridium difficile colitis and ICU length of stay.
Results:  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=0.46; I²= 0%; moderate quality evidence), or in risk of overt GI bleeding (RR 0.83; 95% CI 0.59, 1.16; P = 0.15; I²= 28%; moderate quality evidence). However, there was a statistically significant reduction in the risk of ICU acquired pneumonia with sucralfate use compared to H2RAs (RR 0.84; 95% CI 0.72, 0.98; P=0.21; I2= 22%; moderate quality evidence). Sucralfate use did not significantly affect the risk of death (RR 0.95; 95% CI 0.82, 1.10; P=0.74; 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).
Conclusion: Moderate quality evidence suggests that sucralfate reduced the risk of ICU acquired pneumonia compared to H2RAs, with no significant impact on risk of GI bleeding or other outcomes. Sucralfate can be considered a reasonable alternative for SUP in institutions where pneumonia is common.


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