Proton pump inhibitors in invasively ventilated patients with SARS-CoV-2: a substudy of the re-evaluating the inhibition of stress erosions trial
Year: 2026
Type: article
Abstract: OBJECTIVES: Observational studies suggest that acid suppression may worsen outcomes among patients infected with SARS-CoV-2. The objectives of this embedded substudy of a randomised controlled trial evaluating pantoprazole in mechanically ventilated patients were to (1) describe the clinical characteristics of critically ill patients with SARS-CoV-2, (2) compare clinical outcomes with a propensity-matched non-infected cohort and (3) assess whether pantoprazole's treatment effects differed by SARS-CoV-2 infection status. DESIGN: A pre-planned substudy of the re-evaluating the inhibition of stress erosions (REVISE) trial, including a propensity-matched analysis of infected and non-infected patients comparing the effect of pantoprazole between patients with and without SARS-CoV-2. SETTING: 68 intensive care units (ICUs) in eight countries. PARTICIPANTS: From July 2019 to October 2023, 4821 eligible participants were enrolled in REVISE whether or not they had SARS-CoV-2 infection. PRIMARY AND SECONDARY OUTCOME MEASURES: infection, patient-important upper GI bleeding, renal replacement therapy, ICU and hospital mortality and duration of mechanical ventilation, ICU and hospital stay. RESULTS: Of the eligible trial cohort, 11.9% (540/4550) had SARS-CoV-2; 532 patients had additional SARS-CoV-2-specific data collection. Of these 532 patients, 87.8% received COVID-19-directed treatments-(dexamethasone 75.2%), 11.7% developed pulmonary embolism and 9.2% developed deep-vein thrombosis. After propensity matching, SARS-CoV-2 infection was not associated with clinically important upper gastrointestinal bleeding (adjusted HR 0.78, 95% CI 0.40 to 1.50) but was associated with significantly higher ICU, hospital and 90-day mortality, as well as longer duration of ventilation and ICU and hospital length of stay. The effect of pantoprazole on clinically important upper GI bleeding and 90-day mortality was consistent regardless of SARS-CoV-2 status. CONCLUSIONS: SARS-CoV-2 infection was associated with higher mortality and longer duration of mechanical ventilation, ICU and hospital stays, without an increased risk of clinically important upper gastrointestinal bleeding. Pantoprazole reduced clinically important upper gastrointestinal bleeding without adversely affecting other outcomes. TRIAL REGISTRATION NUMBER: REVISE trial (NCT03374800), SARS-CoV-2 cohort study (NCT05715567).
Source: BMJ Open
Authors: Brittany Dennis, Diane Heels-Ansdell, Quazi Ibrahim, John Basmaji, Lehana Thabane, Gordon Guyatt, Lois Saunders, Lori Hand, Olivia Loy, Nicole Zytaruk, Miranda Hardie, Adam M Deane, John C Marshall, Yaseen Arabi, François Lauzier, Joanna C Dionne, Karen EA Burns, Waleed Alhazzani, Gloria Vazquez-Grande, Anna Geagea, John Myburgh, John Muscedere, Shane English, Alexandra Binnie, Jennifer LY Tsang, Miranda Hunt, Marlies Ostermann, Abdulrahman A Al-Fares, Serena Knowles, Aijaz Ahmed, Deborah J Cook
Institutions: University of British Columbia, McMaster University, Western University, St. Joseph’s Healthcare Hamilton, The University of Melbourne, The George Institute for Global Health, University of Toronto, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, National Guard Health Affairs, Université Laval, Ministry of Defense, Research and Innovation Institute, Imam Abdulrahman Bin Faisal University, University of Manitoba, North York General Hospital, UNSW Sydney, St George Hospital, Queen's University, University of Ottawa, Ottawa Hospital Research Institute, William Osler Health System, Niagara Health System, St Thomas' Hospital, King's College London, Amiri Hospital, Stanford Medicine, Stanford University
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,839
OpenAlex ID: W7204814593