Association of Histamine-2 Blockers and Proton-Pump Inhibitors With Delirium Development in Critically Ill Adults: A Retrospective Cohort Study
OBJECTIVES:. Histamine-2 receptor antagonists are commonly administered for stress ulcer prophylaxis in critically ill adults and may be associated with delirium development. We aimed to determine differential associations of histamine-2 receptor antagonist or proton-pump inhibitor administration wi...
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Wolters Kluwer
2021-08-01
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doaj-017dc092e3ae47e382f26cb1df1c58212021-09-28T10:17:00ZengWolters KluwerCritical Care Explorations2639-80282021-08-0138e050710.1097/CCE.0000000000000507202108000-00007Association of Histamine-2 Blockers and Proton-Pump Inhibitors With Delirium Development in Critically Ill Adults: A Retrospective Cohort StudyAmi Shiddapur, BS0Christine E. Kistler, MD, MASc1Jan Busby-Whitehead, MD2C. Adrian Austin, MD, MSCR31 Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL.2 Divison of Geriatric Medicine, Department of Medicine, University of North Carolina, Chapel Hill, NC.2 Divison of Geriatric Medicine, Department of Medicine, University of North Carolina, Chapel Hill, NC.2 Divison of Geriatric Medicine, Department of Medicine, University of North Carolina, Chapel Hill, NC.OBJECTIVES:. Histamine-2 receptor antagonists are commonly administered for stress ulcer prophylaxis in critically ill adults and may be associated with delirium development. We aimed to determine differential associations of histamine-2 receptor antagonist or proton-pump inhibitor administration with delirium development in patients admitted to a medical ICU. DESIGN:. Retrospective observational study using a deidentified database sourced from the University of North Carolina Health Care system. Participants were identified as having delirium utilizing an International Classification of Diseases-based algorithm. Associations among histamine-2 receptor antagonist, proton-pump inhibitor, or no medication administration and delirium were identified using relative risk. Multiple logistic regression was used to control for potential confounders including mechanical ventilation and age. SETTING:. Academic tertiary care medical ICU in the United States. PATIENTS:. Adults admitted to the University of North Carolina medical ICU from January 2015 to December 2019, excluding those on concurrent histamine-2 receptor antagonists and proton-pump inhibitors in the same encounter. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. We identified 6,645 critically ill patients, of whom 29% (n = 1,899) received mechanical ventilation, 45% (n = 3,022) were 65 or older, and 22% (n = 1,487) died during their medical ICU encounter. Of the 6,645 patients, 31% (n = 2,057) received an histamine-2 receptor antagonist and no proton-pump inhibitors, 40% (n = 2,648) received a proton-pump inhibitor and no histamine-2 receptor antagonists, and 46% (n = 3,076) had delirium. The histamine-2 receptor antagonist group had a greater association with delirium than the proton-pump inhibitor group compared with controls receiving neither medication, after controlling for mechanical ventilation and age (risk ratio, 1.36; 1.25–1.47; p < 0.001) and (risk ratio, 1.15; 1.07–1.24; p < 0.001, respectively). CONCLUSIONS:. Histamine-2 receptor antagonists are more strongly associated with increased delirium than proton-pump inhibitors. Prospective studies are necessary to further elucidate this association and to determine if replacement of histamine-2 receptor antagonists with proton-pump inhibitors in ICUs decreases the burden of delirium in critically ill patients.http://journals.lww.com/10.1097/CCE.0000000000000507 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Ami Shiddapur, BS Christine E. Kistler, MD, MASc Jan Busby-Whitehead, MD C. Adrian Austin, MD, MSCR |
spellingShingle |
Ami Shiddapur, BS Christine E. Kistler, MD, MASc Jan Busby-Whitehead, MD C. Adrian Austin, MD, MSCR Association of Histamine-2 Blockers and Proton-Pump Inhibitors With Delirium Development in Critically Ill Adults: A Retrospective Cohort Study Critical Care Explorations |
author_facet |
Ami Shiddapur, BS Christine E. Kistler, MD, MASc Jan Busby-Whitehead, MD C. Adrian Austin, MD, MSCR |
author_sort |
Ami Shiddapur, BS |
title |
Association of Histamine-2 Blockers and Proton-Pump Inhibitors With Delirium Development in Critically Ill Adults: A Retrospective Cohort Study |
title_short |
Association of Histamine-2 Blockers and Proton-Pump Inhibitors With Delirium Development in Critically Ill Adults: A Retrospective Cohort Study |
title_full |
Association of Histamine-2 Blockers and Proton-Pump Inhibitors With Delirium Development in Critically Ill Adults: A Retrospective Cohort Study |
title_fullStr |
Association of Histamine-2 Blockers and Proton-Pump Inhibitors With Delirium Development in Critically Ill Adults: A Retrospective Cohort Study |
title_full_unstemmed |
Association of Histamine-2 Blockers and Proton-Pump Inhibitors With Delirium Development in Critically Ill Adults: A Retrospective Cohort Study |
title_sort |
association of histamine-2 blockers and proton-pump inhibitors with delirium development in critically ill adults: a retrospective cohort study |
publisher |
Wolters Kluwer |
series |
Critical Care Explorations |
issn |
2639-8028 |
publishDate |
2021-08-01 |
description |
OBJECTIVES:. Histamine-2 receptor antagonists are commonly administered for stress ulcer prophylaxis in critically ill adults and may be associated with delirium development. We aimed to determine differential associations of histamine-2 receptor antagonist or proton-pump inhibitor administration with delirium development in patients admitted to a medical ICU.
DESIGN:. Retrospective observational study using a deidentified database sourced from the University of North Carolina Health Care system. Participants were identified as having delirium utilizing an International Classification of Diseases-based algorithm. Associations among histamine-2 receptor antagonist, proton-pump inhibitor, or no medication administration and delirium were identified using relative risk. Multiple logistic regression was used to control for potential confounders including mechanical ventilation and age.
SETTING:. Academic tertiary care medical ICU in the United States.
PATIENTS:. Adults admitted to the University of North Carolina medical ICU from January 2015 to December 2019, excluding those on concurrent histamine-2 receptor antagonists and proton-pump inhibitors in the same encounter.
INTERVENTIONS:. None.
MEASUREMENTS AND MAIN RESULTS:. We identified 6,645 critically ill patients, of whom 29% (n = 1,899) received mechanical ventilation, 45% (n = 3,022) were 65 or older, and 22% (n = 1,487) died during their medical ICU encounter. Of the 6,645 patients, 31% (n = 2,057) received an histamine-2 receptor antagonist and no proton-pump inhibitors, 40% (n = 2,648) received a proton-pump inhibitor and no histamine-2 receptor antagonists, and 46% (n = 3,076) had delirium. The histamine-2 receptor antagonist group had a greater association with delirium than the proton-pump inhibitor group compared with controls receiving neither medication, after controlling for mechanical ventilation and age (risk ratio, 1.36; 1.25–1.47; p < 0.001) and (risk ratio, 1.15; 1.07–1.24; p < 0.001, respectively).
CONCLUSIONS:. Histamine-2 receptor antagonists are more strongly associated with increased delirium than proton-pump inhibitors. Prospective studies are necessary to further elucidate this association and to determine if replacement of histamine-2 receptor antagonists with proton-pump inhibitors in ICUs decreases the burden of delirium in critically ill patients. |
url |
http://journals.lww.com/10.1097/CCE.0000000000000507 |
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