Summary of findings 9. Antacids compared with sucralfate for preventing upper gastrointestinal bleeding in people admitted to intensive care units.
| Antacids 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: antacids 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 antacids | |||||
| Clinically important upper GI bleeding Follow‐up: 21 days† |
Study population | RR 1.00 (0.72 to 1.39) | 1772 (16 RCTs) | ⊕⊕⊝⊝ LOWa,b | ||
| 66 per 1000 | 66 per 1000 (47 to 91) | |||||
| Nosocomial pneumonia Follow‐up: 25 days‡ |
Study population | RR 1.04 (0.84 to 1.30) | 996 (7 RCTs) | ⊕⊕⊝⊝ LOWa,c | ||
| 232 per 1000 | 242 per 1000 (195 to 302) | |||||
| All‐cause mortality in ICU Follow‐up: 25 days† |
Study population | RR 1.15 (0.93 to 1.40) | 1249 (11 RCTs) | ⊕⊕⊝⊝ LOWa,d | ||
| 206 per 1000 | 237 per 1000 (192 to 289) | |||||
| Duration of ICU stay Follow‐up: not reported |
Mean duration of ICU stay ranged from 10.4 to 16.8 days | MD 2.5 days lower (6.61 days lower to 1.61 days higher) | ‐ | 227 (2 RCTs) | ⊕⊕⊝⊝ LOWa,e | |
| Number of participants requiring blood transfusion Follow‐up: until discharge or onset of GI bleeding§ |
Study population | RR 0.73 (0.40 to 1.34) | 667 (6 RCTs) | ⊕⊕⊝⊝ LOWa,f | ||
| 52 per 1000 | 38 per 1000 (21 to 69) | |||||
| 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 four studies. ‡Duration of follow‐up reported in two studies. §Duration 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 three 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, high risk of reporting bias in two studies, and high risk of other biases in two studies.
cDowngraded by one level for risk of bias because of high risk of performance bias in four studies, high risk of detection bias in one study, high risk of reporting bias in one study, and high risk of other biases in one study.
dDowngraded by one level for risk of bias because of high risk of selection bias in three studies, 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.
eDowngraded by one level for risk of bias because of high risk of attrition bias in one study.
fDowngraded by one level for risk of bias because of high risk of selection bias in one study, high risk of performance bias in six studies, and high risk of other biases in one study.