Evidence map›Paper›PMID 24141808›Full record

SynthesisIntensive care medicine2014

Stress ulcer prophylaxis versus placebo or no prophylaxis in critically ill patients. A systematic review of randomised clinical trials with meta-analysis and trial sequential analysis.

Mette Krag, Anders Perner, Jørn Wetterslev, Matt P Wise, Morten Hylander Møller

Registry-linked trialAbstract readMeta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Intensive care medicine, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02467621 (Stress Ulcer Prophylaxis in the Intensive Care Unit), which is not on this map. Cited by 55 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
55citing papers in PubMed, 9 pooled it
9.0field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02467621 phase4completednot on this mapstarted 2016, after this paper: background citation

Stress Ulcer Prophylaxis in the Intensive Care Unit (SUP-ICU)

TypeinterventionalSponsorDr. Morten Hylander MøllerRan2016 to 2018Enrolled3,350ConditionsGastrointestinal Bleeding, Stress UlcersArmsPantoprazole, Saline (0.9%)
3 · Its place in the literature

Who cites it

55 citing papers in PubMed, 9 syntheses or guidelines pooled it, 148 citations in OpenAlex.

  1. Pooled it
  2. [S3 Guideline Sepsis-prevention, diagnosis, therapy, and aftercare : Long version].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2020
    Guideline
  3. Pooled it
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  7. Guideline
  8. Pooled it
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  10. Trial
  11. Trial
  12. Trial
  13. Article
  14. Article
  15. Review
  16. Prevalence of Depression, Anxiety and Stress Among Patients Discharged from Critical Care Units.Journal of critical care medicine (Universitatea de Medicina si Farmacie din Targu-Mures) · 2021
    Article
  17. Review
  18. Review
  19. Gastrointestinal Issues in Critically Ill Children.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2020
    Review
  20. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

5 authors at 3 institutions in 2 countries.

Mette KragDepartment of Intensive Care, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
Anders Perner
Jørn Wetterslev
Matt P Wise
Morten Hylander Møller
Copenhagen University Hospital · DKRigshospitalet · DKUniversity Hospital of Wales · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo assess the effects of stress ulcer prophylaxis (SUP) versus placebo or no prophylaxis on all-cause mortality, gastrointestinal (GI) bleeding and hospital-acquired pneumonia in adult critically ill patients in the intensive care unit (ICU).

methodsWe performed a systematic review using meta-analysis and trial sequential analysis (TSA). Eligible trials were randomised clinical trials comparing proton pump inhibitors or histamine 2 receptor antagonists with either placebo or no prophylaxis. Two reviewers independently assessed studies for inclusion and extracted data. The Cochrane Collaboration methodology was used. Risk ratios/relative risks (RR) with 95% confidence intervals (CI) were estimated. The predefined outcome measures were all-cause mortality, GI bleeding, and hospital-acquired pneumonia.

resultsTwenty trials (n = 1,971) were included; all were judged as having a high risk of bias. There was no statistically significant difference in mortality (fixed effect: RR 1.00, 95% CI 0.84-1.20; P = 0.87; I(2) = 0%) or hospital-acquired pneumonia (random effects: RR 1.23, 95% CI 0.86-1.78; P = 0.28; I(2) = 19%) between SUP patients and the no prophylaxis/placebo patients. These findings were confirmed in the TSA. With respect to GI bleeding, a statistically significant difference was found in the conventional meta-analysis (random effects: RR 0.44, 95% CI 0.28-0.68; P = 0.01; I(2) = 48%); however, TSA (TSA adjusted 95% CI 0.18-1.11) and subgroup analyses could not confirm this finding.

conclusionsThis systematic review using meta-analysis and TSA demonstrated that both the quality and the quantity of evidence supporting the use of SUP in adult ICU patients is low. Consequently, large randomised clinical trials are warranted.

Indexed as

AdultAnti-Ulcer AgentsCause of DeathChemopreventionCritical IllnessCross InfectionGastrointestinal HemorrhageHistamine H2 AntagonistsHumansLength of StayPeptic UlcerPneumoniaProton Pump InhibitorsRandomized Controlled Trials as TopicRiskStress, PsychologicalAnti-Ulcer AgentsHistamine H2 AntagonistsProton Pump Inhibitors

Identifiers

PMID24141808
OpenAlexW2117993778

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.