Proton pompa inhibitörleri ve toplum kökenli pnömoni riski: Topluma dayalı olgu-kontrol çalışması

AMAÇ: Yakın çalışmalar, proton pompa inhibitörlerinin (PPİ) kullanımının, pnömoni riskini artırdığına işaret etmektedir. Bu çalışmada, bu ilişkiyi doğrulama ve risk faktörlerini belirlemeyi amaçladık. Çalışmanın tipi ve bölgesi: Danimarka, Funen eyaletine ait veri kullanarak, bir topluma dayalı olgu?kontrol çalışması düzenledik. Çalışma popülasyonu: Olgular, 2000?2004 yılları arasında herhangi bir hastaneden pnömoni tanısı almış tüm hastalardı (n=7.642). Yaş ve cinsiyet olarak uyumlandırılmış 34.176 kontrol olguları seçildi. PPİ ve diğer ilaçların kullanımına ait veriler, mikrobiyoloji örnekleri, göğüs radyografisi bulguları ve eşlik eden hastalıklar, yerel kayıtlardan elde edildi. Karıştırıcı faktörler, lojistik regresyon analizi ile kontrol edildi. BULGULAR: PPİ güncel kullanımı ve toplum kökenli pnömoni ilişkisini gösteren düzeltilmiş odds oranı (OO) 1,5 (%95 güven aralığı[GA]; 1,3?1,7) idi. Histamin-2 reseptör antagonistleri (OO, 1,10; %95 GA, 0,8?1,3) ya da PPİ geçmiş kullanımı ile (OO; 1,2; %95, 0,9?1,6) ile bir ilişki bulunmadı. PPİ?lerin yakın zamanda (indeks tarihinden 0?7 gün önce) kullanılmaya başlanması ile daha güçlü bir ilişki bulundu (OO; 5,0; %95 GA 2,1?11,7), ve risk daha uzun süre önce başlamış tedaviye göre azalıyordu (OO; 1,3; %95 GA; 1,2?1,4). Alt grup analizleri, 40 yaş ve daha üstü kişiler için daha yüksek riske işaret etti (OO; 2,3; %95, 1,3?4,0). Doz-yanıt ilişkisi bulunamadı. SONUÇ: PPİ kullanımı, özellikle yakın zamanda kullanıma başlandığında, toplum kökenli pnömoni riski artışı ile ilişkilidir.

Use of proton pump ınhibitors and the risk of community-acquired pneumonia: A population-based case-control study

BACKGROUND: Recently, the use of proton pump inhibitors (PPIs) has been associated with an increased risk of pneumonia. We aimed to confirm this association and to identify the risk factors. METHODS: We conducted a population-based case-control study using data from the County of Funen, Denmark. Cases (n=7642) were defined as all patients with a first-discharge diagnosis of community-acquired pneumonia from a hospital during 2000 through 2004. We also selected 34,176 control subjects, who were frequency matched to the cases by age and sex. Data on the use of PPIs and other drugs, on microbiological samples, on x-ray examination findings, and on comorbid conditions were extracted from local registries. Confounders were controlled by logistic regression. RESULTS: The adjusted odds ratio (OR) associating current use of PPIs with community-acquired pneumonia was 1.5 (95% confidence interval [CI], 1.3-1.7). No association was found with histamine2-receptor antagonists (OR, 1.10; 95% CI, 0.8-1.3) or with past use of PPIs (OR, 1.2; 95% CI, 0.9-1.6). Recent initiation of treatment with PPIs (0-7 days before index date) showed a particularly strong association with community-acquired pneumonia (OR, 5.0; 95% 2.1-11.7), while the risk decreased with treatment that was started a long time ago (OR, 1.3; 95% CI, 1.2-1.4). Subgroup analyses revealed high ORs for users younger than 40 years (OR, 2.3; 95% CI, 1.3-4.0). No dose-response effect could be demonstrated. CONCLUSION: The use of PPIs, especially when recently begun, is associated with an increased risk of community-acquired pneumonia.

Kaynakça

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