Summary of findings 8. H2 receptor antagonists compared with sucralfate for preventing upper gastrointestinal bleeding in people admitted to intensive care units.
| H2 receptor antagonists compared with sucralfate 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: sucralfate | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with sucralfate | Risk with H2 receptor antagonists | |||||
| Clinically important upper GI bleeding Follow‐up: 15 days† |
Study population | RR 1.10 (0.87 to 1.41) | 3316 (24 RCTs) | ⊕⊕⊝⊝ LOWa,b | ||
| 66 per 1000 | 73 per 1000 (58 to 93) | |||||
| Nosocomial pneumonia Follow‐up: 25 days‡ |
Study population | RR 1.22 (1.07 to 1.40) | 3041 (17 RCTs) | ⊕⊕⊕⊝ MODERATEc | ||
| 189 per 1000 | 230 per 1000 (202 to 264) | |||||
| All‐cause mortality in ICU Follow‐up: 25 days§ |
Study population | RR 1.09 (0.95 to 1.24) | 3178 (21 RCTs) | ⊕⊕⊝⊝ LOWa,d | ||
| 204 per 1000 | 222 per 1000 (194 to 253) | |||||
| Duration of ICU stay Follow‐up: 2 weeks |
Mean duration of ICU stay ranged from 7.9 to 13.7 days | MD 0.01 days higher (1.92 days lower to 1.95 days higher) | ‐ | 1791 (6 RCTs) | ⊕⊝⊝⊝ VERY LOWa,e,f | |
| Number of participants requiring blood transfusion Follow‐up: until death or dischargeǁ |
Study population | RR 1.25 (0.70 to 2.23) | 1095 (9 RCTs) | ⊕⊕⊝⊝ LOWa,g | ||
| 35 per 1000 | 43 per 1000 (24 to 77) | |||||
| 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 five studies. ‡Duration of follow‐up reported in three studies. §Duration of follow‐up reported in six studies. ǁDuration of follow‐up reported in 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 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 one study, high risk of performance bias in 20 studies, high risk of detection bias in two studies, high risk of attrition bias in two studies, high risk of reporting bias in four studies, and high risk of other biases in two studies.
cDowngraded 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 one study, high risk of attrition bias in one study, and high risk of reporting bias in two studies.
dDowngraded by one level for risk of bias because of high risk of selection bias in two studies, high risk of performance bias in 16 studies, high risk of detection bias in one study, high risk of attrition bias in two studies, high risk of reporting bias in three studies, and high risk of other biases in one study.
eDowngraded by one level for inconsistency because of considerable heterogeneity; I² = 82%.
fDowngraded by one level for risk of bias because of high risk of performance bias in four studies and high risk of attrition bias in one study.
gDowngraded by one level for risk of bias because of high risk of performance bias in eight studies, high risk of attrition bias in one study, high risk of reporting bias in one study, and high risk of other biases in one study.