他汀类药物可降低黎巴嫩脓毒症患者的死亡率：一项多中心研究。

Statins decrease mortality in Lebanese patients with sepsis: A multicenter study.

作者信息

Ajrouche Rola, Al-Hajje Amal, El-Helou Nancy, Awada Sanaa, Rachidi Samar, Zein Salam, Salameh Pascale

机构信息

Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy & Clinical Pharmacy department, Doctoral School of Sciences & Technology. Lebanese University. Beirut ( Lebanon ).

出版信息

Pharm Pract (Granada). 2013 Apr;11(2):102-8. doi: 10.4321/s1886-36552013000200007. Epub 2013 Jun 30.

DOI:10.4321/s1886-36552013000200007

PMID:24155857

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3798175/

Abstract

BACKGROUND

Sepsis is a significant public health concern. The clinical response to statins is variable among sepsis patients.

OBJECTIVE

The aim of the study was to determinate the effect of statin-treatment on mortality in Lebanese patients with sepsis.

METHODS

A retrospective multicenter study on Lebanese patients with sepsis between January 2008 and March 2012 was conducted. Patients with a primary diagnosis of sepsis admitted to the intensive care unit of two tertiary care hospitals in Beirut were included. Patients who continued to receive statin therapy for dyslipidemia during the hospital course were included in the statin treatment group. The control group consisted of patients not taking statin. Demographic characteristics, clinical signs, standard laboratory test and treatment received were compared between these two groups using univariate analysis. Logistic regression and survival analysis were performed by SPSS.

RESULTS

THREE HUNDRED FIFTY ONE LEBANESE PATIENTS WERE INCLUDED (AGE: 71.33 SD=14.97 years; Male: 56%). Among them, 30% took a statin at the doses recommended for dyslipidemia. The comparison of the two groups showed that in the statin treatment group: The mean serum level of C-reactive protein at the time of sepsis was significantly decreased (P=0.050), the length-stay at ICU significantly increased (P=0.047) and mortality significantly reduced (P<0.001). Results were confirmed by logistic regression, particularly for mortality. In the Cox regression analysis, hypothermia and shock were significantly associated with high mortality while statin treatment decreased mortality (hazard ratio = 0.540; 95% CI: 0.302-0.964; P=0.037).

CONCLUSIONS

At usual doses for dyslipidemia, statin treatment decreased incidence of mortality related to sepsis and improved the survival in this Lebanese septic population. Large randomized controlled clinical trials must be realized to give conclusive results about the potential beneficial effect of statins in sepsis.

摘要

背景

脓毒症是一个重大的公共卫生问题。脓毒症患者对他汀类药物的临床反应存在差异。

目的

本研究旨在确定他汀类药物治疗对黎巴嫩脓毒症患者死亡率的影响。

方法

对2008年1月至2012年3月期间的黎巴嫩脓毒症患者进行了一项回顾性多中心研究。纳入在贝鲁特两家三级护理医院重症监护病房住院、初步诊断为脓毒症的患者。在住院期间因血脂异常继续接受他汀类药物治疗的患者被纳入他汀类药物治疗组。对照组由未服用他汀类药物的患者组成。使用单因素分析比较两组患者的人口统计学特征、临床体征、标准实验室检查和接受的治疗。通过SPSS进行逻辑回归和生存分析。

结果

共纳入351名黎巴嫩患者（年龄：71.33，标准差=14.97岁；男性：56%）。其中，30%的患者按照血脂异常推荐剂量服用他汀类药物。两组比较显示，在他汀类药物治疗组中：脓毒症发作时C反应蛋白的平均血清水平显著降低（P=0.050），在重症监护病房的住院时间显著延长（P=0.047），死亡率显著降低（P<0.001）。逻辑回归分析证实了这些结果，尤其是死亡率方面。在Cox回归分析中，体温过低和休克与高死亡率显著相关，而他汀类药物治疗可降低死亡率（风险比=0.540；95%置信区间：0.302-0.964；P=0.037）。