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Infectious diseases
Research
Population-based cohort study on the risk of pneumonia in patients with non-traumatic intracranial haemorrhage who use proton pump inhibitors
  1. Sai-Wai Ho1,2,
  2. Ming-Che Tsai1,2,
  3. Ying-Hock Teng1,2,
  4. Ying-Tung Yeh3,
  5. Yu-Hsun Wang4,
  6. Shun-Fa Yang4,5,
  7. Chao-Bin Yeh1,2
  1. 1Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
  2. 2Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
  3. 3School of Dentistry, Chung Shan Medical University, Taichung, Taiwan
  4. 4Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
  5. 5Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
  1. Correspondence to Dr Chao-Bin Yeh; sky5ff{at}gmail.com

Abstract

Objectives This 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).

Design Nationwide population-based cohort study.

Setting Longitudinal Health Insurance Database 2010 (LHID2010) sampled from the Taiwan National Health Insurance Research Database.

Participants 4644 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 measure Patients using PPIs or not during the study period were tracked to identify the occurrence of any type of pneumonia.

Results The 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.

Conclusions The 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.

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This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

http://dx.doi.org/10.1136/bmjopen-2014-006710

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