The association between proton pump inhibitor use and outcome after aneurysmal subarachnoid hemorrhage

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.

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.

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)).

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.