Population-based cohort study on the risk of pneumonia in patients with non-traumatic intracranial haemorrhage who use proton pump inhibitors

Abstract

ObjectivesThis nationwide cohort study investigated the association between proton pump inhibitor (PPI) usage and the risk of pneumonia in patients with non-traumatic intracranial haemorrhage (ICH).DesignNationwide population-based cohort study.SettingLongitudinal Health Insurance Database 2010 (LHID2010) sampled from the Taiwan National Health Insurance Research Database.Participants4644 patients with non-traumatic ICH from 2010 to 2011 were identified. Patients aged <18 years and newly diagnosed with non-traumatic ICH complicated with pneumonia during the same admission period were excluded. A total of 2170 participants were eligible for the final analysis.Main outcome measurePatients using PPIs or not during the study period were tracked to identify the occurrence of any type of pneumonia.ResultsThe adjusted HR of the risk of pneumonia for ICH patients who used PPIs was 1.61 (95% CI 1.32 to 1.97, p<0.001). The risk of pneumonia was positively associated with the administration of PPIs. We observed a greater risk of pneumonia in patients who used PPIs than in those who did not. Moreover, we observed that the risk of pneumonia in patients who used PPIs was 2.60 and 2.04 (95% CI 2.01 to 3.38, p<0.001; 95% CI 1.34 to 3.10, p<0.001) greater than that in patients who did not use PPIs when the defined daily dose was <30 and 30−60, respectively.ConclusionsThe results of this study indicate that the use of PPIs in patients with non-traumatic ICH is associated with an increased risk of pneumonia, and the severity of this risk depends on the defined daily dose. Physicians should exercise caution when prescribing PPIs for patients with non-traumatic ICH.

Risk of pneumonia in patients with gastroesophageal reflux disease: A population-based cohort study

“…Previous studies conducted using the NHIRD have shown that patients with stroke [ 13 ] or COPD [ 14 , 15 ] have non-significant risk of pneumonia. By contrast, PPI use in individuals with nontraumatic intracranial hemorrhage was at a high risk of long-term pneumonia [ 16 ]. Therefore, the association between PPI use and long-term risk of pneumonia was not well established.…”

Peer Review #2 of "Incidence and risk of dialysis therapy within 30 days after contrast enhanced computed tomography in patients coded with chronic kidney disease: a nation-wide, population-based study (v0.1)"

“…For research purposes, a subset of database, namely, the Longitudinal Health Insurance Database 2010 (LHID2010), was provided by the National Health Research Institutes, and it had been implemented in numerous research articles. (Chang et al 2015;Chou et al 2015;Ho et al 2014;Wu et al 2014) This dataset contains of one million individuals chosen randomly from the NHIRD at the year 2010 and contains medical information from January 1997 to December 2013 of each subject under the coverage. The Catastrophic Illness Registry Data file was supplemented for identification of deaths during the study period.…”

Reply to: Proton Pump Inhibitors and Risk of Pneumonia in Individuals with Dementia

“…Previous studies have reported that proton pump inhibitors (PPIs) are positively associated with the risk of community-acquired pneumonia (CAP) for various disease and age populations [3][4][5][6][7][8] , but the letter mentioned, "The author of the manuscript has not clearly described or validated the swallowing test in these dementia patients. Swallowing problems are the one of most common causes of pneumonia.…”