Summary of findings 7. H2 receptor antagonists compared with antacids for preventing upper gastrointestinal bleeding in people admitted to intensive care units.
| H2 receptor antagonists compared with antacids 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: antacids | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with antacids | Risk with H2 receptor antagonists | |||||
| Clinically important upper GI bleeding Follow‐up: 25 days† |
Study population | RR 0.96 (0.67 to 1.36) | 1700 (16 RCTs) | ⊕⊕⊝⊝ LOWa,b | ||
| 86 per 1000 | 82 per 1000 (57 to 117) | |||||
| Nosocomial pneumonia Follow‐up: 25 days‡ |
Study population | RR 1.05 (0.81 to 1.36) | 581 (4 RCTs) | ⊕⊕⊝⊝ LOWa,c | ||
| 280 per 1000 | 294 per 1000 (227 to 381) | |||||
| All‐cause mortality in ICU Follow‐up: 25 days§ |
Study population | RR 1.01 (0.66 to 1.55) | 1321 (11 RCTs) | ⊕⊝⊝⊝ VERY LOWa,d,e | ||
| 163 per 1000 | 165 per 1000 (108 to 253) | |||||
| Duration of ICU stay | Not reported | |||||
| Number of participants requiring blood transfusion Follow‐up: not reported |
Study population | RR 2.49 (1.35 to 4.62) | 744 (6 RCTs) | ⊕⊕⊕⊝ MODERATEf | ||
| 30 per 1000 | 75 per 1000 (41 to 139) | |||||
| 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 two studies. ‡Duration of follow‐up reported in one study. §Duration of follow‐up reported in three studies. CI: confidence interval; GI: gastrointestinal; ICU: intensive care unit; 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 imprecision because 95% CI was compatible with benefit and harm.
bDowngraded by one level for risk of bias because of high risk of selection bias in two studies, high risk of performance bias in 12 studies, high risk of detection bias in two studies, and high risk of reporting bias in two studies.
cDowngraded by one level for risk of bias because of high risk of selection bias in one study, high risk of performance bias in four studies, high risk of detection bias in one study, and high risk of reporting bias in one study.
dDowngraded by one level for inconsistency because of moderate heterogeneity; I² = 53%.
eDowngraded by one level for risk of bias because of high risk of selection bias in two studies, high risk of performance bias in nine studies, and high risk of reporting bias in one study.
fDowngraded by one level for risk of bias because of high risk of selection bias in one study and high risk of performance bias in four studies.