Pulmonary and Critical Care Medicine, Henry Ford Hospital, K-17, 2799 West Grand Blvd, 48202 Detroit, MI USA.
Department of Pharmacy, Henry Ford Hospital, K-17, 2799 West Grand Blvd, 48202 Detroit, MI USA.
Ann Intensive Care. 2015 May 6;5:9. doi: 10.1186/s13613-015-0049-9. eCollection 2015.
The purpose of this study is to compare the in-hospital mortality rates between septic patients receiving statins and those that did not prior to developing sepsis. We compared subgroups receiving atorvastatin and simvastatin because these two drugs differ in their pharmacologic properties.
This study was a retrospective analysis of patients selected from an institutional data base of patients hospitalized with sepsis. The study patients were drawn from a data base of 1,961 hospitalized patients with sepsis and included patients who met selection criteria and who were studied for HMG-CoA reductase inhibitor (statin) use both prior to and during hospitalization. The in-hospital mortality rates of patients receiving statins and those that did not prior to developing sepsis were compared. In-hospital mortality rates of patient subgroups receiving atorvastatin and simvastatin were also compared. A multivariable analysis was conducted with in-hospital mortality as the outcome variable and with multiple risk factors to include atorvastatin and simvastatin use.
The mortality rate for 359 patients receiving statins prior to hospitalization for sepsis was not significantly different than that for 1,302 patients who did not receive pre-hospital statins (26.5% versus 30.4%, p > 0.05). The mortality rate for 92 patients who had received atorvastatin prior to hospitalization was significantly less than that of 253 patients who received simvastatin (18.5% versus 30.0%, p = 0.032). The use of atorvastatin prior to sepsis was independently associated with lower in-hospital mortality in a multivariable analysis of sepsis risk factors (p = 0.021, OR = 0.455). Patients who received atorvastatin prior to hospitalization for sepsis and had statins continued in hospital had a very low mortality rate that was significantly less than that of those patients who never received statins (15.7% versus 30.8%, p = 0.007).
Pre-hospital atorvastatin use was associated with improved in-hospital mortality in septic patients when compared with pre-hospital simvastatin use and was independently associated with an improved outcome when compared to other sepsis risk factors. The effect of statins in patients with sepsis may be different for individual statins.
本研究旨在比较在发生脓毒症之前接受他汀类药物和未接受他汀类药物治疗的脓毒症患者的院内死亡率。我们比较了阿托伐他汀和辛伐他汀的亚组，因为这两种药物在药理特性上有所不同。
这是一项回顾性分析，从一个机构的脓毒症住院患者数据库中选择患者。研究患者来自 1961 名住院脓毒症患者的数据库，包括符合选择标准且在住院期间和之前均接受 HMG-CoA 还原酶抑制剂（他汀类药物）治疗的患者。比较接受他汀类药物治疗和未在发生脓毒症前接受他汀类药物治疗的患者的院内死亡率。还比较了接受阿托伐他汀和辛伐他汀治疗的患者亚组的院内死亡率。采用多变量分析，以院内死亡率为结局变量，并纳入多个危险因素，包括阿托伐他汀和辛伐他汀的使用。
在因脓毒症住院前接受他汀类药物治疗的 359 名患者中，死亡率与未在住院前接受他汀类药物治疗的 1302 名患者无显著差异（26.5%比 30.4%，p>0.05）。在因脓毒症住院前接受阿托伐他汀治疗的 92 名患者中，死亡率显著低于接受辛伐他汀治疗的 253 名患者（18.5%比 30.0%，p=0.032）。在多变量分析脓毒症危险因素时，在因脓毒症住院前使用阿托伐他汀与院内死亡率降低独立相关（p=0.021，OR=0.455）。在因脓毒症住院前接受阿托伐他汀治疗且继续在医院使用他汀类药物的患者的死亡率非常低，明显低于从未接受过他汀类药物治疗的患者（15.7%比 30.8%，p=0.007）。
与在发生脓毒症前使用辛伐他汀相比，在发生脓毒症前使用阿托伐他汀与改善脓毒症患者的院内死亡率相关，并且与其他脓毒症危险因素相比，与改善预后相关。在脓毒症患者中，他汀类药物的作用可能因个体他汀类药物而异。
