Hospital Universitari de Bellvitge, IDIBELL (Institut D'investigació Biomèdica de Bellvitge), Universitat de Barcelona, Barcelona, Spain.
PLoS One. 2013 Oct 14;8(10):e77317. doi: 10.1371/journal.pone.0077317. eCollection 2013.
Statins have immunomodulatory properties and hinder Candida growth. However, it is unknown whether they may improve prognosis in patients with candidemia. We sought to determine the effect of prior statin use on the clinical outcomes of patients suffering candidemia.
Multicenter cohort study of hospitalized adults with candidemia between 2005 and 2011 in six hospitals in Spain, Brazil and Argentina. Of 326 candidemias, 44 (13.5%) occurred in statin users and 282 (86.5%) in statin non-users. The median value of APACHE II at candidemia diagnosis was similar between groups (18 vs. 16; p=.36). Candida albicans was the most commonly isolated species, followed by C. parapsilosis, C. tropicalis, C. glabrata, and C. krusei. There were no differences regarding appropriate empirical antifungal treatment. Statin users had a lower early (5 d) case-fatality rate than non-users (4.5 vs. 17%; p=.031). This effect was not observed with other cardiovascular drugs (aspirin, beta blockers and ACE inhibitors). Independent factor related to early case-fatality rate was APACHE II score (AOR, 1.08; 95% CI, 1.03-1.14; p=.002). An appropriate empirical antifungal therapy (AOR, 0.11; 95% CI, 0.04-0.26; p=<.001) and prior statin use were independently associated with lower early case-fatality (AOR, 0.17; 95% CI, 0.03-0.93; p=.041). Fourteen days (14d) and overall (30d) case-fatality rates were similar between groups (27% vs. 29%; p=0.77 and 40% vs. 44%; p=.66).
The use of statins might have a beneficial effect on outcomes of patients with candidemia. This hypothesis deserves further evaluation in randomized trials.
他汀类药物具有免疫调节作用，并能抑制念珠菌生长。然而，目前尚不清楚它们是否能改善念珠菌血症患者的预后。我们旨在确定既往使用他汀类药物对念珠菌血症患者临床结局的影响。
这是一项在西班牙、巴西和阿根廷的 6 家医院进行的 2005 至 2011 年期间住院成人念珠菌血症的多中心队列研究。326 例念珠菌血症中，44 例（13.5%）发生在他汀类药物使用者中，282 例（86.5%）发生在他汀类药物非使用者中。两组患者在念珠菌血症诊断时的急性生理与慢性健康状况评分Ⅱ（APACHEⅡ）中位数相似（18 与 16；p=0.36）。最常分离到的念珠菌物种为白念珠菌，其次为近平滑念珠菌、热带念珠菌、光滑念珠菌和克柔念珠菌。两组患者经验性抗真菌治疗的选择无差异。他汀类药物使用者的早期（5 天）病死率低于非使用者（4.5%与 17%；p=0.031）。但这一效果在其他心血管药物（阿司匹林、β受体阻滞剂和血管紧张素转换酶抑制剂）中未观察到。与早期病死率相关的独立因素为 APACHEⅡ评分（比值比，1.08；95%置信区间，1.03-1.14；p=0.002）。经验性抗真菌治疗恰当（比值比，0.11；95%置信区间，0.04-0.26；p<.001）和既往使用他汀类药物与较低的早期病死率独立相关（比值比，0.17；95%置信区间，0.03-0.93；p=0.041）。两组患者 14 天（14d）和 30 天（30d）病死率相似（27%与 29%；p=0.77 和 40%与 44%；p=0.66）。
他汀类药物的使用可能对念珠菌血症患者的结局有有益影响。这一假说值得进一步在随机试验中评估。
