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The Association Between Proton Pump Inhibitor Use and Outcome After Aneurysmal Subarachnoid Hemorrhage

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Abstract

Background

For many patients with aneurysmal subarachnoid hemorrhage (SAH), initiation of acid suppression therapy is concordant with guidelines and has become standard of care in neurological intensive care units. The aim of this study was to evaluate the association between type of acid suppression therapy and outcome following aneurysmal SAH.

Methods

Retrospective cohort study of consecutive aneurysmal SAH patients identified over a 5 year period. Of 297 patients identified, 148 met inclusion criteria for analysis. Multivariable logistic regression was performed to evaluate the independent association between type of acid suppression therapy (proton pump inhibitor (PPI) vs histamine 2 receptor antagonist (H2A)) and the outcomes of delayed neurological deficits (DNDs), delayed infarction and favorable functional outcome defined as a modified Rankin Scale ≤ 2.

Results

Forty-two patients were treated with a PPI and 106 with a H2A. Baseline characteristics were well-matched between groups with the exception of year of treatment and prophylactic antiepileptic medication. Patients placed on a PPI were less likely to have a favorable functional outcome than those on a H2A (45 vs 64%; P = 0.035). In adjusted analysis, no association was identified between PPI use and DNDs (OR 1.18 (95% confidence interval: 0.48–2.88)) or delayed infarction (OR 1.64 (0.64–4.16)); however, PPI use was associated with a lower odds of favorable functional outcome (OR 0.37 (0.16–0.85)).

Conclusions

Type of acid suppression therapy was not associated with DNDs or delayed infarction following aneurysmal SAH. However, PPI use was associated with poorer functional outcome. Further study of acid suppression therapy and PPI use following SAH is warranted.

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Conflict of interest

The authors declare no conflicts of interest or financial disclosures.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Michigan Health System, 3552 Taubman Health Care Center, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5338, USA

    Jeffrey J. Fletcher, Venkatakrishna Rajajee & Teresa L. Jacobs

  2. Department of Neurology, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5855, USA

    Devin L. Brown

  3. Department of Anesthesia, University of Michigan Health System, 1H247 UH, SPC 5048, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA

    Lauryn Rochlen

  4. Department of Emergency Medicine, University of Michigan Health System, Taubman Center B1 354F, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA

    William Meurer

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  1. Jeffrey J. Fletcher
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  2. Devin L. Brown
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  3. Venkatakrishna Rajajee
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  4. Teresa L. Jacobs
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  5. Lauryn Rochlen
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  6. William Meurer
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Correspondence to Jeffrey J. Fletcher.

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Fletcher, J.J., Brown, D.L., Rajajee, V. et al. The Association Between Proton Pump Inhibitor Use and Outcome After Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care 15, 393–399 (2011). https://doi.org/10.1007/s12028-011-9532-9

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  • DOI: https://doi.org/10.1007/s12028-011-9532-9

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