Good morning, everyone. Thank you to the SSCM for being here, for the opportunity. Our study is titled Timeless Cessation of Proton Pump Inhibitors in Critical Ill Patients Impacts Morbidity and Mortality, a Propensity Score Match Cohort Study. And all authors declare no conflicts of interest and no funding was received. So let us examine proton pump inhibitors. The major representative of the drug class of proton pump inhibitors are pentopretzol, omepretzol, and esomepretzol. And the mechanism of action is an irreversible inhibition of the proton pump in the stomach. And we're facing the following situation. Proton pump inhibitors are among the most commonly prescribed medications worldwide. And they're ranked third among the most prescribed medications nationwide in Germany in 2021. And approximately 40% of all patients over the age of 17 regularly use proton pump inhibitors. So let's take a look at the diverse spectrum of indications. And for an intensivist, the term gastrointestinal bleeding will catch attention. A major focus of PPI therapy on the ICU resolves around stress ulcer prophylaxis. Depending on the study, up to 90% of patients on the ICU are treated with proton pump inhibitors. And currently, it's up to debate which patients actually benefit from SUP. But what's not up to debate is that SUP is only a temporary indication. And therefore, timely cessation is essential. However, PPI therapy initiated in the ICU is at risk of being continued throughout the patient's hospital course and even beyond discharge. So let's take a look at the potential side effects of PPI therapy. And it gets evident that potential side effects are pre-described in the literature in a diverse way. And it would be particularly tragic if patients suffer from side effects of PPI therapy, although they do not require PPI therapy anymore. And here our work begins. We tested the hypothesis that continuation of PPI therapy without an indication beyond hospital discharge is associated with an increased incident of adverse effects, an increased re-hospitalization rate, or an increased mortality. And a retrospective analysis of data from a large German health insurer. Our aim was to form a cohort of patients who received an ICU treatment and who were critically ill and exhibited the following additional characteristics. Not receiving PPI therapy before hospital admission. A newly initiated PPI treatment during the ICU stay. And no coded indication for PPI therapy beyond eight weeks after hospital discharge. Our study cohorts composition and certification were as follows. 11,576 ICU patients were included who received proton pump inhibitor therapy for the first time during the ICU stay. And no one of them had an indication for its continuation. Patients in group A did not receive further proton pump inhibitor therapy beyond hospital discharge as they had no indication. In contrast, patients in group B had their PPI therapy initiated in the ICU, continued after hospital discharge, and as just described, without an appropriate indication. And to test our hypothesis, we established the following three endpoints. The incidence of pre-described adverse events associated with PPI therapy, the re-hospitalization rate within one year, and the mortality rate in two years. And for good comparability of the groups, we conducted propensity score matching, including a total of 12 variables. So let's move on to the results. Here you see the baseline characteristics of our matched cohort. And it becomes immediately evident that 4,825 patients out of the total cohort of over 11,000 patients received PPI therapy beyond hospital discharge. This correspondence to a proportion of 41.7% of former ICU patients who were discharged from the hospital was ongoing, unnecessary PPI therapy. Now I'd like to draw your attention back to the baseline characteristics. Through propensity score matching, we achieved a proper comparability. And in particular, some concomitant medications were of interest, like anticoagulants, antiplatelet medications, NSAIDs, or glucocorticoids. We also aimed for matching by the comorbid conditions. And here you see a balance ratio except for chronic kidney disease, diabetes, and hypertension, but with a trend towards a higher disease severity in the non-PPI group. Other variables we aimed for comparability were the primary ICU conditions within 10 categories, and also some relevant secondary diagnosis acquired during ICU stay, like acute kidney injury or sepsis. Here you see the re-hospitalization rate and a selection of pre-described adverse events in association with PPI therapy. First, let's take a look at the re-hospitalization rate. And it becomes evident that continuation of PPI therapy without an appropriate indication is associated with a 35% increased risk of re-hospitalization within the first year. Considering gastrointestinal and renal diseases, there were more frequent diagnosis of clostridium difficile infections and chronic kidney disease in association with PPI therapy. Patients suffered more frequently from cardiopulmonary diseases. There was an increase of 17% of the risk of cardiovascular events, and 27% increased risk for pneumonia. There were increased incidences of malignant diseases like esophageal cancer, colorectal cancer, and pancreatic cancer in association of prolonged PPI therapy without an indication. And finally, when examining malabsorption disorders like vitamin B12 deficiency, hypomagnesemia, and hypercalcemia, there was an increased risk in association with PPI therapy. And now let's take a look at the mortality. Here you see a Kaplan-Meier curve. On the x-axis, you see the days after hospital discharge. And on the y-axis, you see the percentage survival of our cohort. And when examining the timeline, you see that during the first year, there's no significant difference in the mortality rate. But when examining the second year, it becomes evident that there is a 17% increase of mortality risk in association with prolonged PPI therapy without an indication. So summarizing our findings, the proportion of patients with continued PPI therapy without an objectifiable indication was 41.7%, or in absolute numbers, 4,825 out of over 11,000 patients. And continuation of this PPI therapy post-hospital discharge is associated with increased morbidity, a 35% increased risk for re-hospitalization within the first year, and 17% increased mortality risk observed over a period of two years, which leads me to my final slide. We identified an excessive overtreatment with PPI in prior critical patients after hospital discharge. And this unnecessary continuation of PPI therapy has implications for both morbidity and mortality. And finally, our data necessitate more attention from ICU physicians regarding communication and interventions to ensure the time discontinuation of an only temporary indicated PPI therapy. Thank you very much. Thank you.

proton pump inhibitors

ICU patients

morbidity and mortality

therapy cessation

overtreatment