Evidence map›Paper›PMID 35213716›Full record

Trial reportEuropean journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery2022

Efficacy and safety of proton pump inhibitors versus histamine-2 receptor blockers in the cardiac surgical population: insights from the PEPTIC trial.

Sean van Diepen, Tim Coulson, Xiaoming Wang, Dawn Opgenorth, Danny J Zuege, Jo Harris, Malik Agyemang, Daniel J Niven, Rinaldo Bellomo, Stephen E Wright and 3 more

Open access · bronzeAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
1.5field-weighted citation impact, top 19% 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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 10 citations in OpenAlex.

  1. Article
  2. Gastrointestinal complications after cardiac surgery.Trauma surgery & acute care open · 2024
    Review
  3. Article
  4. Article
  5. Stress ulcer prophylaxis in the cardiac surgery intensive care unit.European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2022
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors at 5 institutions in 4 countries.

Sean van DiepenDepartment of Critical Care Medicine, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada.ORCID 0000-0002-6688-828X
Tim CoulsonDepartment of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne, VIC, Australia.
Xiaoming WangHealth Services Statistical and Analytic Methods, Alberta Health Services, Calgary, AB, Canada.
Dawn OpgenorthDepartment of Critical Care Medicine, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada.ORCID 0000-0003-3571-3871
Danny J ZuegeDepartment of Critical Care Medicine, University of Calgary, Alberta Health Services, Calgary, AB, Canada.
Jo HarriseCritical Alberta, Alberta Health Services, Calgary, AB, Canada.
Malik AgyemangDepartment of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
Daniel J NivenDepartment of Critical Care Medicine, University of Calgary, Alberta Health Services, Calgary, AB, Canada.ORCID 0000-0002-9527-0577
Rinaldo BellomoAustralian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.ORCID 0000-0002-1650-8939
Stephen E WrightIntensive Care Unit, Freeman Hospital, Newcastle upon Tyne, UK.
Paul J YoungAustralian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Sean M BagshawDepartment of Critical Care Medicine, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada.ORCID 0000-0003-3633-6596
PEPTIC study investigators and the ANZICS Clinical Trials Group
Alberta Health Services · CAThe University of Melbourne · AUFreeman Hospital · GBThe Royal Melbourne Hospital · AUUniversity of Calgary · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesThe comparative effectiveness and safety of proton pump inhibitors (PPIs) versus histamine-2 receptor blockers for stress ulcer prophylaxis in the cardiac surgical intensive care unit population is uncertain. Although the Proton Pump Inhibitors versus Histamine-2 Receptor Blockers for Ulcer Prophylaxis Therapy in the Intensive Care Unit (PEPTIC) trial reported a higher risk of mortality in the PPI arm with no difference in gastrointestinal bleeding, detailed information on surgical variables and clinically relevant surgical subgroups was not available.

methodsThe analysis included all Canadian cardiac surgery patients enrolled in the PEPTIC trial. Data were electronically linked using unique patient identifiers to a clinical information system. Outcomes of interest included in-hospital mortality, gastrointestinal bleeding, Clostridium difficile infections, ventilator-associated conditions and length of stay.

resultsWe studied 823 (50.6%) randomized to PPIs and 805 (49.4%) to histamine-2-receptor blockers. In the intention-to-treat analysis, there were no differences in hospital mortality [PPI: 4.3% vs histamine-2 receptor blockers: 4.8%, adjusted odds ratio (aOR) 0.97, 95% confidence interval (CI) 0.55-1.70], gastrointestinal bleeding (3.9% vs 4.8%, aOR 1.09, 95% CI 0.66-1.81), C. difficile infections (0.9% vs 0.1%, aOR 0.18, 95% CI 0.02-1.59), ventilator-associated conditions (1.6% vs 1.7%, aOR 0.92, 95% CI 0.85-1.00) or median length of stay (9.2 vs 9.8 days, adjusted risk ratio 1.06, 85% CI 0.99-1.13). No significant treatment differences were observed among subgroups of interest or per-protocol populations.

conclusionsIn a secondary analysis of cardiac surgery patients enrolled in the PEPTIC trial in Canada, no differences in effectiveness or safety were observed between use of PPIs and histamine-2 receptor blockers for stress ulcer prophylaxis. CLINICAL TRIAL REGISTRATION NUMBER: anzctr.org.au identifier: ACTRN12616000481471.

Indexed as

Cardiac Surgical ProceduresClostridioides difficilePeptic UlcerStomach UlcerCanadaGastrointestinal HemorrhageHistamineHistamine H2 AntagonistsHumansProton Pump InhibitorsUlcerHistamineHistamine H2 AntagonistsProton Pump InhibitorsCardiac surgical intensive care unitClostridium difficile infectionsGastrointestinal bleedingStress ulcer prophylaxisVentilator-associated conditions

Identifiers

PMID35213716
PMCPMC9334785
OpenAlexW4211014785

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.