Summary of findings 6. H2 receptor antagonists compared with proton pump inhibitors for preventing upper gastrointestinal bleeding in people admitted to intensive care units.
| H2 receptor antagonists compared with proton pump inhibitors for preventing upper gastrointestinal bleeding in people admitted to intensive care units | ||||||
| Patient or population: people admitted to intensive care units Setting: ICU Intervention: H2 receptor antagonists Comparison: proton pump inhibitors | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with proton pump inhibitors | Risk with H2 receptor antagonists | |||||
| Clinically important upper GI bleeding Follow‐up: not reported |
Study population | RR 2.90 (1.83 to 4.58) | 1636 (13 RCTs) | ⊕⊕⊝⊝ LOWa,b | ||
| 25 per 1000 | 73 per 1000 (46 to 115) | |||||
| Nosocomial pneumonia Follow‐up: 30 days† |
Study population | RR 1.02 (0.77 to 1.35) | 1256 (10 RCTs) | ⊕⊕⊝⊝ LOWc,d | ||
| 123 per 1000 | 126 per 1000 (95 to 166) | |||||
| All‐cause mortality in ICU Follow‐up: 30 days† |
Study population | RR 0.96 (0.78 to 1.19) | 1564 (12 RCTs) | ⊕⊕⊝⊝ LOWc,e | ||
| 158 per 1000 | 152 per 1000 (124 to 189) | |||||
| Duration of ICU stay Follow‐up: not reported |
Mean duration of ICU stay ranged from 7.7 to 23.6 days | MD 0.14 days higher (1.14 days lower to 1.41 days higher) | ‐ | 482 (5 RCTs) | ⊕⊕⊝⊝ LOWc,f | |
| Number of participants requiring blood transfusion Follow‐up: not reported |
Study population | RR 1.98 (0.75 to 5.21) | 575 (3 RCTs) | ⊕⊕⊕⊝ MODERATEc | ||
| 17 per 1000 | 35 per 1000 (13 to 91) | |||||
| Serious adverse events | Not reported | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). †Duration of follow‐up reported in only one study. CI: confidence interval; GI: gastrointestinal; ICU: intensive care unit; MD: mean difference; RCT: randomised controlled trial; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence. High certainty: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect. Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect. | ||||||
aDowngraded by one level for inconsistency because of substantial heterogeneity; I² = 59%.
bDowngraded by one level for risk of bias because of high risk of selection bias in one study, high risk of performance bias in five studies, high risk of detection bias in two studies, and high risk of other biases in one study.
cDowngraded by one level for imprecision because 95% CI was compatible with benefit and harm.
dDowngraded by one level for risk of bias because of high risk of performance bias in four studies, high risk of detection bias in two studies, and high risk of other biases in one study.
eDowngraded by one level for risk of bias because of high risk of performance bias in five studies, high risk of attrition bias in one study, and high risk of other biases in one study.
fDowngraded by one level for risk of bias because of high risk of performance bias in three studies, high risk of attrition bias in one study, and high risk of other biases in one study.