Zechmeister Carrie, Hurren Jeff, McNorton Kelly
Spectrum Health Department of Pharmacy, Grand Rapids, MI, USA
St John Hospital and Medical Center Department of Pharmacy, Detroit, MI, USA.
Ann Pharmacother. 2015 Jul;49(7):790-5. doi: 10.1177/1060028015579987. Epub 2015 Apr 20.
Studies have evaluated the use of statins in sepsis; however, no human studies have explored their effect on vasopressor requirements in septic shock.
The primary objective was to determine the effect of prehospital statin continuation on duration of vasopressor therapy in patients with septic shock. Secondary objectives included maximum and average vasopressor dose and in-hospital mortality.
This was a retrospective, institutional board-approved, observational cohort study in a community teaching hospital; 119 adult intensive care unit (ICU) patients with an ICD-9 code for septic shock and prehospital statin therapy were evaluated. Multivariate analyses were performed to address confounders.
Of the 1229 patients screened, 119 (10%) met inclusion criteria; 73 patients (61%) had a statin continued within 24 hours of ICU admission. Crude analysis demonstrated no difference in vasopressor duration in the statin versus no statin group (3.3 vs 4.8 days; P = 0.21). There was no difference in either maximum (17.9 ± 16.1 vs 23.8 ± 21.7 µg/min norepinephrine equivalents [NEQs]; P = 0.1) or average vasopressor dose (9.5 ± 8.4 vs 12.1 ± 11.5 µg/min NEQ; P = 0.17). There was a decrease in mortality in the statin patients (43% vs 67 %; P = 0.05). On adjustment for potential confounders, there was no difference in any outcome, with a persistent trend toward lower mortality in the statin group.
Continuation of prehospital statin therapy decreased neither duration nor dose of vasopressors in patients with septic shock but yielded a trend toward decreased mortality.
已有研究评估了他汀类药物在脓毒症中的应用；然而，尚无人体研究探讨其对感染性休克患者血管升压药需求的影响。
主要目的是确定院前继续使用他汀类药物对感染性休克患者血管升压药治疗持续时间的影响。次要目的包括血管升压药的最大剂量和平均剂量以及住院死亡率。
这是一项在社区教学医院进行的回顾性、经机构委员会批准的观察性队列研究；对119例有脓毒性休克ICD-9编码且接受院前他汀类药物治疗的成人重症监护病房（ICU）患者进行了评估。进行多变量分析以处理混杂因素。
在筛选的1229例患者中，119例（10%）符合纳入标准；73例患者（61%）在ICU入院后24小时内继续使用他汀类药物。粗分析显示，他汀类药物组与未使用他汀类药物组的血管升压药持续时间无差异（3.3天对4.8天；P = 0.21）。最大血管升压药剂量（去甲肾上腺素等效物[NEQs]分别为17.9±16.1对23.8±21.7µg/min；P = 0.1）或平均血管升压药剂量（9.5±8.4对12.1±11.5µg/min NEQ；P = 0.17）均无差异。他汀类药物治疗的患者死亡率有所下降（43%对67%；P = 0.05）。在对潜在混杂因素进行调整后，任何结局均无差异，他汀类药物组死亡率仍有降低趋势。
院前他汀类药物治疗的持续应用既未降低感染性休克患者血管升压药的持续时间和剂量，但有降低死亡率的趋势。
