Comparison of Histamine-2 Receptor Antagonists and Proton Pump Inhibitors for Stress Ulcer Prophylaxis in Patients With Septic Shock
Main findingResult — go to the resultOdds ratio 0.78 95% CI 0.64–0.96Authors' conclusion
In this large, diverse cohort of U.S. hospitalized adults with septic shock, PPI use for stress ulcer prophylaxis was associated with a significantly lower occurrence of UGIB compared with H2RA, with no significant differences in mortality, ventilator-associated pneumonia, C. difficile infection, or hospital length of stay.
Study context
- Population
- Adults with septic shock started on H2RAs or proton pump inhibitors (PPIs) on the day of hospital admission, 220 US community and teaching hospitals
- Participants
- 15,102 adults
- Exposure
- PPIs vs H2RAs for stress ulcer prophylaxis
- H2RAn = 5,492reference
- PPIn = 9,610
- Outcome
- Occurrence of upper gastrointestinal bleeding (UGIB)
- Follow-up
- During hospitalization
Methodological detailsmulticentre, propensity-weighted (inverse probability of treatment weighting (IPTW))
- Multicentre
- Propensity-weighted (IPTW)
Main finding
As reported in the abstract
Odds ratio
0.78
95% CI 0.64–0.96
P = 0.016
PPI vs H2RA
OR 0.78 (95% CI 0.64–0.96); P = 0.016
Observational data: associations, not effects.
Secondary outcomes
| Outcome | OR (95% CI) | P value | |
|---|---|---|---|
| UGIB, famotidine vs pantoprazole (sensitivity analysis)Confirmed primary finding · IPTW-adjusted | 0.80 (0.65–0.97) | P = 0.025 | |
| 0.512Odds ratio (log scale) |
In-hospital mortality
- No significant difference; OR
- 0.98 (95% CI 0.91-1.06; p = 0.691)
- IPTW-adjusted
Ventilator-associated pneumonia
- No significant difference; OR
- 0.93 (95% CI 0.83-1.04; p = 0.188)
- IPTW-adjusted
Hospital LOS
- No significant difference; incidence rate ratio
- 1.01 (95% CI 0.98-1.05; p = 0.417)
- IPTW-adjusted
Safety
C. difficile infection
- No significant difference; OR
- 1.32 (95% CI 0.82-2.13; p = 0.246)
- IPTW-adjusted
Original publication
Comparison of Histamine-2 Receptor Antagonists and Proton Pump Inhibitors for Stress Ulcer Prophylaxis in Patients With Septic Shock. Crit Care Med. Published 17 December 2025. doi:10.
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