Caffrey Aisling R, Timbrook Tristan T, Noh Eunsun, Sakoulas George, Opal Steven M, Nizet Victor, LaPlante Kerry L
Veterans Affairs Medical Center, Infectious Diseases Research Program and Center of Innovation in Long Term Services and Supports, Providence, Rhode Island, USA
University of Rhode Island College of Pharmacy, Kingston, Rhode Island, USA.
Antimicrob Agents Chemother. 2017 Feb 23;61(3). doi: 10.1128/AAC.02228-16. Print 2017 Mar.
In addition to cholesterol-lowering capabilities, statins possess anti-inflammatory and immunomodulatory effects. We sought to quantify the real-world impact of different statin exposure patterns on clinical outcomes in bacteremia. We conducted a retrospective cohort study among hospitalized patients with positive blood cultures receiving appropriate antibiotics within 48 h of culture collection (Veterans Affairs hospitals, 2002 to 2013). Three statin exposure groups were compared to nonusers: pretreated statin users initiating therapy in the 30 days prior to culture and either (i) continuing statin therapy after culture or (ii) not continuing after culture, and (iii) users initiating at culture. Nonusers included patients without statins in the year prior to culture through discharge. Propensity score-matched Cox proportional hazards regression models were developed. We were able to balance significantly different baseline characteristics using propensity score matching for pretreated without continuation ( = 331), pretreated with continuation ( = 141), and ( = 177) statin users compared to nonusers. We observed a significantly lower 30-day mortality rate (hazard ratio [HR], 0.46; 95% confidence interval [CI], 0.25 to 0.84; number needed to treat [NNT], 10) among pretreated and continued statin users, while protective effects were not observed in (HR, 1.04; 95% CI, 0.60 to 1.82; NNT, undefined) or pretreated but not continued (HR, 0.92; 95% CI, 0.64 to 1.32; NNT, 47) users. In our national cohort study among patients with bacteremia, continuation of statin therapy among incident statin users was associated with significant beneficial effects on mortality, including a 54% lower 30-day mortality rate.
除了具有降低胆固醇的能力外，他汀类药物还具有抗炎和免疫调节作用。我们试图量化不同他汀类药物暴露模式对菌血症临床结局的实际影响。我们对2002年至2013年期间在退伍军人事务医院住院且血培养结果为阳性并在采集培养物后48小时内接受适当抗生素治疗的患者进行了一项回顾性队列研究。将三个他汀类药物暴露组与未使用者进行比较：在培养前30天开始治疗的预先使用他汀类药物的使用者，以及（i）培养后继续使用他汀类药物治疗或（ii）培养后不继续使用他汀类药物治疗的使用者，以及（iii）在培养时开始使用他汀类药物的使用者。未使用者包括从培养前一年到出院期间未使用他汀类药物的患者。构建了倾向评分匹配的Cox比例风险回归模型。与未使用者相比，我们能够通过倾向评分匹配显著平衡预先使用他汀类药物但未继续使用（n = 331）、预先使用他汀类药物并继续使用（n = 141）以及（n = 177）他汀类药物使用者之间显著不同的基线特征。我们观察到，预先使用他汀类药物并继续使用的使用者30天死亡率显著降低（风险比[HR]，0.46；95%置信区间[CI]，0.25至0.84；治疗所需人数[NNT]，10），而在（HR，1.04；95%CI，0.60至1.82；NNT，未定义）或预先使用他汀类药物但未继续使用（HR，0.92；95%CI，0.64至1.32；NNT，47）的使用者中未观察到保护作用。在我们针对菌血症患者的全国队列研究中，新使用他汀类药物的患者继续使用他汀类药物治疗与对死亡率有显著有益影响相关，包括30天死亡率降低54%。
