Goodin J, Manrique C, Dulohery M, Sampson J, Saettele M, Dabbagh O
Division of Pulmonary, Critical Care and Environmental Medicine, University of Missouri School of Medicine, Columbia, Missouri 65212, USA.
Anaesth Intensive Care. 2011 Nov;39(6):1051-5. doi: 10.1177/0310057X1103900611.
Despite numerous attempts at novel intervention and tests to aid in earlier diagnosis and improved treatment, there has been an increased incidence of overall mortality related to sepsis, despite improvements in in-hospital mortality. Statins have emerged as potential immunomodulatory and antioxidant agents that might impact on sepsis outcomes. Definitive evidence to support the routine use of statins in patients with sepsis has not yet been elicited. We retrospectively analysed data from patients who presented with sepsis, severe sepsis or septic shock, stratifiying them according to statin use into two groups (statin and no statin). Sequential Organ Failure Assessment was used to evaluate severity of illness. The primary outcome was hospital mortality. Secondary outcomes included intensive care unit (ICU) mortality, hospital and ICU length of stay, and mechanical ventilation and vasopressor therapy duration. Five hundred and sixty-eight patients were included. Patients with prior statin use (statin group) were older; more obese and had higher prevalence of smoking, diabetes and ischaemic heart disease. There was no difference in Sequential Organ Failure Assessment scores and mortality did not vary between the two groups (19.6 vs. 16.9%). Furthermore, secondary outcomes including ICU mortality, hospital and ICU length of stay, mechanical ventilation and vasopressor duration did not differ Multivariate analysis revealed age and Sequential Organ Failure Assessment score were independent predictors of survival, while history of statin use was not (p = 0.403). This current retrospective study did not find any benefit of statin use on primary and secondary outcomes of the patients admitted to an academic hospital with sepsis.
尽管人们多次尝试进行新型干预和测试以辅助早期诊断并改善治疗，但尽管住院死亡率有所改善，与脓毒症相关的总体死亡率仍呈上升趋势。他汀类药物已成为可能影响脓毒症预后的潜在免疫调节和抗氧化剂。尚未获得支持在脓毒症患者中常规使用他汀类药物的确切证据。我们回顾性分析了脓毒症、严重脓毒症或脓毒性休克患者的数据，根据他汀类药物的使用情况将他们分为两组（使用他汀类药物组和未使用他汀类药物组）。采用序贯器官衰竭评估来评估疾病的严重程度。主要结局是住院死亡率。次要结局包括重症监护病房（ICU）死亡率、住院时间和ICU住院时间，以及机械通气和血管活性药物治疗持续时间。共纳入568例患者。既往使用他汀类药物的患者（他汀类药物组）年龄更大；肥胖程度更高，吸烟、糖尿病和缺血性心脏病的患病率更高。序贯器官衰竭评估评分没有差异，两组之间的死亡率也没有变化（19.6%对16.9%）。此外，包括ICU死亡率、住院时间和ICU住院时间、机械通气和血管活性药物使用时间在内的次要结局也没有差异。多变量分析显示年龄和序贯器官衰竭评估评分是生存的独立预测因素，而他汀类药物使用史不是（p = 0.403）。这项当前的回顾性研究未发现使用他汀类药物对入住学术医院的脓毒症患者的主要和次要结局有任何益处。
