Mehl A, Harthug S, Lydersen S, Paulsen J, Åsvold B O, Solligård E, Damås J K, Edna T-H
Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Post Box 333, 7601, Levanger, Norway,
Eur J Clin Microbiol Infect Dis. 2015 Mar;34(3):609-17. doi: 10.1007/s10096-014-2269-6. Epub 2014 Nov 6.
In several studies on patients with bloodstream infection (BSI), prior use of statins has been associated with improved survival. Gram-positive and Gram-negative bacteria alert the innate immune system in different ways. We, therefore, studied whether the relation between prior statin use and 90-day total mortality differed between Gram-positive and Gram-negative BSI. We conducted a prospective observational cohort study of 1,408 adults with BSI admitted to Levanger Hospital between January 1, 2002, and December 31, 2011. Data on the use of statins and other medications at admission, comorbidities, functional status, treatment, and outcome were obtained from the patients' hospital records. The relation of statin use with 90-day mortality differed between Gram-negative and Gram-positive BSI (p-value for interaction 0.01). Among patients with Gram-negative BSI, statin users had significantly lower 90-day total mortality [odds ratio (OR) 0.42, 95 % confidence interval (CI) 0.23-0.75, p = 0.003]. The association remained essentially unchanged after adjusting for the effect of sex, age, functional status before the infection, and underlying diseases that were considered confounders (adjusted OR 0.38, 95 % CI 0.20-0.72, p = 0.003). A similar analysis of patients with Gram-positive BSI showed no association of statin use with mortality (adjusted OR 1.22, 95 % CI 0.69-2.17, p = 0.49). The present study suggests that prior statin use is associated with a lower 90-day total mortality in Gram-negative BSI, but not in Gram-positive BSI.
在多项针对血流感染（BSI）患者的研究中，先前使用他汀类药物与生存率提高有关。革兰氏阳性菌和革兰氏阴性菌以不同方式激活先天性免疫系统。因此，我们研究了在革兰氏阳性菌和革兰氏阴性菌引起的血流感染中，先前使用他汀类药物与90天总死亡率之间的关系是否存在差异。我们对2002年1月1日至2011年12月31日期间入住莱万格医院的1408例成人血流感染患者进行了一项前瞻性观察队列研究。入院时他汀类药物和其他药物的使用情况、合并症、功能状态、治疗及转归数据均来自患者的医院记录。革兰氏阴性菌和革兰氏阳性菌引起的血流感染中，他汀类药物使用与90天死亡率的关系存在差异（交互作用的P值为0.01）。在革兰氏阴性菌引起的血流感染患者中，使用他汀类药物的患者90天总死亡率显著降低[比值比（OR）为0.42，95%置信区间（CI）为0.23 - 0.75，P = 0.003]。在对性别、年龄、感染前功能状态及被视为混杂因素的基础疾病的影响进行校正后，该关联基本保持不变（校正后的OR为0.38，95% CI为0.20 - 0.72，P = 0.003）。对革兰氏阳性菌引起的血流感染患者进行的类似分析显示，他汀类药物使用与死亡率之间无关联（校正后的OR为1.22，95% CI为0.69 - 2.17，P = 0.49）。本研究表明，先前使用他汀类药物与革兰氏阴性菌引起的血流感染患者90天总死亡率降低有关，但与革兰氏阳性菌引起的血流感染无关。
