The Effect Of Omeprazole Exposure On All-cause Mortality And Length Of ICU/Hospital Stay In Critically Ill Pediatric Patients:A Retrospective Cohort Study

Objective:Pediatric patients admitted to intensive care unit(ICU)are critically ill with high mortality,and the physiological mechanism is quite different from that of adult patients.It was difficult to rationally prescribed medicine in critically ill underage patients.Although proton pump inhibitors(PPIs)are frequently given to pediatric patients in ICU,the effect of PPIs on mortality and length of stay in real-world clinical settings remains uncertain.The aim of the present study was to investigate the association between PPIs administration and outcomes of critical ill underage patients based on Pediatric-specific Intensive Care(PIC)database.Methods:The study was retrospective research.According to pre-determined inclusion and exclusion criteria,we extracted and collated clinical data of underage critically ill patients from PIC database.If patients were admitted to ICU multiple times,only the first ICU admission was analyzed.In PIC database,PPI record only included omeprazole(OME).So we categorized patients who used OME during hospitalization into OME group,while the remaining patients made up the non-OME group.Baseline characteristics and clinical outcomes of pediatric patients admitted to ICU in medication treatment group and non-medication treatment group were reviewed and compared.Propensity score matching(PSM)was applied to balance the baseline differences between two groups that exposed to PPIs or not.Kaplan–Meier curves and Cox proportional hazards model were used to assess the effects of PPIs on 28-day and hospital mortality.Linear regression model was also employed to estimate the relationship between PPIs administration and length of ICU and hospital stay in critically ill underage patients.Results:A total of 2269 underage ICU patients were included into our research,involving 1378 OME users and 891 non-OME users.The results showed significant association between OME exposure and decreased ICU stay(β-0.073;95% CI-0.114--0.031;P = 0.001)and prolonged non-ICU hospital stay(β 0.10;95% CI 0.054-0.146;P < 0.001).No statistical significance was observed between OME exposure and reduced mortality,but the OME users group had a slightly decreased tendency in 28-day mortality(HR 0.783;95% CI 0.407-1.507)and in-hospital mortality(HR 0.734;95% CI 0.388-1.389).Furthermore,subgroups analyses revealed that the decreased tendency of mortality were more obvious in patients less than 1years old than those of older pediatric patients,although not statistically significant.In addition,we also observed that OME exposure was significantly associated with reducing mortality in General intensive care unit(GICU)subgroup.Conclusions:This study provided a sign that PPIs used only in the ICU,rather than throughout hospital stay,might provide more benefit for critically ill underage patients and younger pediatric patients might gain relatively more benefit than older children when receiving PPIs.