Fernandez Rafael, De Pedro Victor Jose, Artigas Antonio
Critical Care Center, Hospital de Sabadell, Institut Universitari Parc Tauli, Universitat Autonoma de Barcelona, Parc Taulí s/n, 08208 Sabadell, Spain.
Intensive Care Med. 2006 Jan;32(1):160-4. doi: 10.1007/s00134-005-2743-9. Epub 2005 Aug 16.
Examine the impact of previous statin therapy on hospital mortality and whether it is due to a protective effect against ICU-acquired infections.
Cohort comparison study by retrospective chart-based analysis in a 26-bed, university-affiliated, medical-surgical ICU.
We analyzed data from 438 patients at high risk of ICU-acquired infections, i.e., those receiving mechanical ventilation for more than 96 h, 38 (8.7%) of whom had been treated with statins prior to and during ICU admission.
We recorded clinical characteristics, number and type of ICU-acquired infections, and ICU and hospital mortality. Statin-treated patients were older (71.7+/-8.3 vs. 61.5+/-18.3 years), but differences in predicted mortality risk by APACHE II (39.5+/-24.7 vs. 35.8+/-24.3%) did not reach statistical significance. The ICU-acquired infection rate in statin-treated patients was nonsignificantly lower (29% vs. 38%) and delayed (median 12 vs.10 days), without differences regarding the source of infections. Nevertheless, hospital mortality was significantly higher in statin-treated patients (61% vs. 42%), even after adjustment for APACHE II predicted risk (observed/expected ratio 1.53 vs. 1.17).
Statin therapy is associated with worse outcome, probably because underlying clinical conditions are insufficiently considered in mortality predictors. Its presumed protective effect against ICU infections remains unconfirmed.
研究既往他汀类药物治疗对医院死亡率的影响，以及其是否归因于对重症监护病房（ICU）获得性感染的保护作用。
通过对一家拥有26张床位的大学附属医院内科-外科ICU的病历进行回顾性分析，开展队列比较研究。
我们分析了438例有ICU获得性感染高风险患者的数据，即那些接受机械通气超过96小时的患者，其中38例（8.7%）在ICU住院前及住院期间接受过他汀类药物治疗。
我们记录了临床特征、ICU获得性感染的数量和类型，以及ICU和医院死亡率。接受他汀类药物治疗的患者年龄更大（71.7±8.3岁 vs. 61.5±18.3岁），但急性生理与慢性健康状况评分系统（APACHE II）预测的死亡风险差异（39.5±24.7% vs. 35.8±24.3%）未达到统计学意义。接受他汀类药物治疗的患者ICU获得性感染率略低（29% vs. 38%）且出现时间延迟（中位数为12天 vs. 10天），感染源方面无差异。然而，即使在对APACHE II预测风险进行调整后，接受他汀类药物治疗的患者医院死亡率仍显著更高（61% vs. 42%）（观察/预期比值为1.53 vs. 1.17）。
他汀类药物治疗与更差的预后相关，可能是因为在死亡率预测指标中未充分考虑潜在的临床状况。其对ICU感染的假定保护作用仍未得到证实。
