Majumdar Sumit R, McAlister Finlay A, Eurich Dean T, Padwal Raj S, Marrie Thomas J
Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
BMJ. 2006 Nov 11;333(7576):999. doi: 10.1136/bmj.38992.565972.7C. Epub 2006 Oct 23.
To determine whether statins reduce mortality or need for admission to intensive care in patients admitted to hospital with community acquired pneumonia; and to assess whether previously reported improvements in sepsis related outcomes were a result of the healthy user effect.
Population based prospective cohort study.
Six hospitals in Capital Health, Edmonton, Alberta, Canada.
Adults admitted to hospital with pneumonia and categorised according to use of statins for at least one week before admission and during hospital stay.
Composite of in-hospital mortality or admission to an intensive care unit.
Of 3415 patients with pneumonia admitted to hospital, 624 (18%) died or were admitted to an intensive care unit. Statin users were less likely to die or be admitted to an intensive care unit than non-users (50/325 (15%) v 574/3090 (19%), odds ratio 0.80, P=0.15). After more complete adjustment for confounding, however, the odds ratios changed from potential benefit (0.78, adjusted for age and sex) to potential harm (1.10, fully adjusted including propensity scores, 95% confidence interval 0.76 to 1.60).
Statins are not associated with reduced mortality or need for admission to an intensive care unit in patients with pneumonia; reports of benefit in the setting of sepsis may be a result of confounding.
确定他汀类药物是否能降低社区获得性肺炎住院患者的死亡率或重症监护需求；并评估先前报道的脓毒症相关预后改善是否是健康用户效应的结果。
基于人群的前瞻性队列研究。
加拿大艾伯塔省埃德蒙顿市首都健康中心的六家医院。
因肺炎住院的成年人，根据入院前至少一周及住院期间他汀类药物的使用情况进行分类。
院内死亡率或入住重症监护病房的综合情况。
3415例肺炎住院患者中，624例（18%）死亡或入住重症监护病房。他汀类药物使用者比非使用者死亡或入住重症监护病房的可能性更小（50/325例（15%）对574/3090例（19%），比值比0.80，P = 0.15）。然而，在对混杂因素进行更全面调整后，比值比从潜在获益（0.78，经年龄和性别调整）变为潜在危害（1.10，完全调整包括倾向得分，95%置信区间0.76至1.60）。
他汀类药物与肺炎患者死亡率降低或重症监护需求无关；脓毒症情况下获益的报道可能是混杂因素的结果。
