Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Chest. 2018 Apr;153(4):805-815. doi: 10.1016/j.chest.2017.09.024. Epub 2017 Sep 27.
Whether statin treatment, proved by recent experimental studies to have an antimicrobial activity, exerts a drug- or a class-specific effect in sepsis remains unknown.
Short-term mortality in patients with sepsis was analyzed using data from the National Health Insurance Research Database. Use of statins was defined as the cumulative use of a specific statin (atorvastatin, simvastatin, or rosuvastatin) for > 30 days prior to the index sepsis admission. We determined the association between statin and sepsis outcome by multivariate-adjusted Cox models and propensity score (PS)-matched analysis, using a 1:1:1 PS matching technique.
A total of 52,737 patients with sepsis fulfilled the inclusion criteria, of which 1,855 were prescribed atorvastatin, 916 were prescribed simvastatin, and 732 were prescribed rosuvastatin. Compared with nonusers, simvastatin (hazard ratio [HR], 0.72; 95% CI, 0.58-0.90) and atorvastatin (HR, 0.78; 95% CI, 0.68-0.90) were associated with an improved 30-day survival, whereas rosuvastatin was not (HR, 0.87; 95% CI, 0.73-1.04). Using rosuvastatin as the reference, atorvastatin (HR, 0.79; 95% CI, 0.64-0.99) and simvastatin (HR, 0.77; 95% CI, 0.59-0.99) had superior effectiveness in preventing mortality.
Compatible with in vitro experimental findings, our results suggest that the drug-specific effect of statins on sepsis is not correlated to their lipid-lowering potency.
他汀类药物最近的实验研究证明具有抗菌活性，但在脓毒症中是否发挥药物或类特异性作用尚不清楚。
利用国家健康保险研究数据库中的数据分析脓毒症患者的短期死亡率。他汀类药物的使用定义为在指数脓毒症入院前> 30 天内累积使用特定他汀类药物（阿托伐他汀、辛伐他汀或瑞舒伐他汀）。我们通过多变量调整的 Cox 模型和倾向评分（PS）匹配分析确定他汀类药物与脓毒症结局之间的关系，使用 1:1:1 PS 匹配技术。
共有 52737 名符合纳入标准的脓毒症患者，其中 1855 名患者被处方阿托伐他汀，916 名患者被处方辛伐他汀，732 名患者被处方瑞舒伐他汀。与未使用者相比，辛伐他汀（危险比 [HR]，0.72；95%置信区间 [CI]，0.58-0.90）和阿托伐他汀（HR，0.78；95%CI，0.68-0.90）与 30 天生存率提高相关，而瑞舒伐他汀则不然（HR，0.87；95%CI，0.73-1.04）。以瑞舒伐他汀为参照，阿托伐他汀（HR，0.79；95%CI，0.64-0.99）和辛伐他汀（HR，0.77；95%CI，0.59-0.99）在预防死亡率方面更有效。
与体外实验研究结果一致，我们的结果表明，他汀类药物对脓毒症的药物特异性作用与其降脂效力无关。
