Center for Quality of Care Research, Baystate Medical Center, Springfield, MA 01199, USA.
J Gen Intern Med. 2012 Mar;27(3):280-6. doi: 10.1007/s11606-011-1826-2. Epub 2011 Aug 13.
Statins are prescribed to lower cholesterol, but also have anti-inflammatory properties. Some observational studies suggest that statins may reduce mortality from sepsis.
Using a highly detailed administrative database, we conducted an observational cohort study of all patients aged ≥18 years who received a discharge diagnosis of pneumonia from 2003-2005 at 376 hospitals. Patients with contraindications to statins, and those unable to take oral medications or discharged within 2 days were excluded. We used multivariable logistic regression and propensity matching to compare mortality among patients who did and did not receive statins on hospital day 1 or 2.
Of the 121,254 patients who met the inclusion criteria, median age was 74; 56% were female and 70% were white; 19% received a statin on day 1 or 2. Compared to patients who did not receive statins, statin-treated patients were less likely to be admitted to intensive care (15.7% vs 18.1%, p < 0.001), require mechanical ventilation (6.9% vs. 9.3%, p < 0.001), or die in hospital (3.9% vs 5.7%, p < 0.001). After multivariable adjustment, including the propensity for statin treatment and severity at presentation, mortality was lower in statin-treated patients [OR for propensity-adjusted 0.86 (95% CI 0.79 to 0.93) OR for propensity-matched 0.90, (0.82 to 0.99)]. For patients admitted to intensive care the adjusted odds ratio for mortality with statins was 0.93 (95% CI 0.81 to 1.06), whereas outside intensive care it was 0.79 (95% CI 0.71 to 0.87).
Inpatient treatment with statins is associated with a modest reduction in pneumonia mortality outside of intensive care.
他汀类药物被用于降低胆固醇，但也具有抗炎作用。一些观察性研究表明，他汀类药物可能降低脓毒症的死亡率。
我们使用高度详细的行政数据库，对 2003 年至 2005 年期间在 376 家医院接受肺炎出院诊断的所有年龄≥18 岁的患者进行了一项观察性队列研究。排除了有他汀类药物禁忌证、无法口服药物或住院 2 天内出院的患者。我们使用多变量逻辑回归和倾向匹配来比较在住院第 1 天或第 2 天接受和未接受他汀类药物治疗的患者的死亡率。
在符合纳入标准的 121254 名患者中，中位年龄为 74 岁；56%为女性，70%为白人；19%在第 1 天或第 2 天接受他汀类药物治疗。与未接受他汀类药物治疗的患者相比，接受他汀类药物治疗的患者更不可能入住重症监护病房（15.7% vs 18.1%，p<0.001）、需要机械通气（6.9% vs. 9.3%，p<0.001）或院内死亡（3.9% vs 5.7%，p<0.001）。在校正了倾向于接受他汀类药物治疗和入院时严重程度等因素后，接受他汀类药物治疗的患者死亡率较低[倾向调整后的 OR 为 0.86（95%CI 0.79 至 0.93），倾向匹配后的 OR 为 0.90（0.82 至 0.99）]。对于入住重症监护病房的患者，使用他汀类药物治疗的死亡率调整后比值比为 0.93（95%CI 0.81 至 1.06），而在重症监护病房外为 0.79（95%CI 0.71 至 0.87）。
住院期间使用他汀类药物治疗与重症监护病房外肺炎死亡率适度降低相关。
