Hu Sung-Yuan, Hsieh Ming-Shun, Lin Tzu-Chieh, Liao Shu-Hui, Hsieh Vivian Chia-Rong, Chiang Jen-Huai, Chang Yan-Zin
Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung.
Institute of Medicine, Chung Shan Medical University, Taichung.
Medicine (Baltimore). 2019 Apr;98(17):e15253. doi: 10.1097/MD.0000000000015253.
Most patients diagnosed with sepsis died during their first episode, with the long-term survival rate upon post-sepsis discharge being low. Major adverse cardiovascular events and recurrent infections were regarded as the major causes of death. No definite medications had proven to be effective in improving the long-term prognosis. We aimed to examine the benefits of statins on the long-term prognosis of patients who had survived sepsis.Between 1999 and 2013, a total of 220,082 patients who had been hospitalized due to the first episode of sepsis were included, with 134,448 (61.09%) of them surviving to discharge. The surviving patients who were subsequently prescribed statins at a concentration of more than 30 cumulative Defined Daily Doses (cDDDs) during post-sepsis discharge were defined as the users of statin.After a propensity score matching ratio of 1:5, a total of 7356 and 36,780 surviving patients were retrieved for the study (statin users) and comparison cohort (nonstatin users), respectively. The main outcome was to determine the long-term survival rate during post-sepsis discharge.HR with 95% CI was calculated using the Cox regression model to evaluate the effectiveness of statins, with further stratification analyses according to cDDDs.The users of statins had an adjusted HR of 0.29 (95% CI, 0.27-0.31) in their long-term mortality rate when compared with the comparison cohort. For the users of statins with cDDDs of 30-180, 180-365, and >365, the adjusted HRs were 0.32, 0.22, and 0.16, respectively, (95% CI, 0.30-0.34, 0.19-0.26, and 0.12-0.23, respectively), as compared with the nonstatins users (defined as the use of statins <30 cDDDs during post-sepsis discharge), with the P for trend <.0001. In the sensitivity analysis, after excluding the surviving patients who had died between 3 and 6 months after post-sepsis discharge, the adjusted HR for the users of statins remained significant (0.35, 95% CI 0.32-0.37 and 0.42, 95% CI 0.39-0.45, respectively).Statins may have the potential to decrease the long-term mortality of patients who have survived sepsis. However, more evidence, including clinical and laboratory data, is necessary in order to confirm the results of this observational cohort study.Trial registration: CMUH104-REC2-115.
大多数被诊断为脓毒症的患者在首次发病期间死亡，脓毒症后出院的长期生存率较低。主要不良心血管事件和反复感染被视为主要死因。尚无明确药物被证明对改善长期预后有效。我们旨在研究他汀类药物对脓毒症幸存者长期预后的益处。
1999年至2013年期间，共纳入220,082例因首次脓毒症发作而住院的患者，其中134,448例（61.09%）存活至出院。在脓毒症后出院期间随后被处方累积定义日剂量（cDDD）超过30的他汀类药物的存活患者被定义为他汀类药物使用者。
在倾向评分匹配比例为1:5后，分别为研究（他汀类药物使用者）和对照队列（非他汀类药物使用者）检索到7356例和36,780例存活患者。主要结局是确定脓毒症后出院期间的长期生存率。
使用Cox回归模型计算95%置信区间的风险比（HR）以评估他汀类药物的有效性，并根据cDDD进行进一步分层分析。
与对照队列相比，他汀类药物使用者的长期死亡率调整后HR为0.29（95%CI，0.27 - 0.31）。对于cDDD为30 - 180、180 - 365和>365的他汀类药物使用者，与非他汀类药物使用者（定义为脓毒症后出院期间使用他汀类药物<30 cDDD）相比，调整后HR分别为0.32、0.22和0.16（95%CI分别为0.30 - 0.34、0.19 - 0.26和0.12 - 0.23），趋势P <.0001。在敏感性分析中，排除脓毒症后出院3至6个月内死亡的存活患者后，他汀类药物使用者的调整后HR仍然显著（分别为0.35，95%CI 0.32 - 0.37和0.42，95%CI 0.39 - 0.45）。
他汀类药物可能有降低脓毒症幸存者长期死亡率的潜力。然而，需要更多证据，包括临床和实验室数据，以证实这项观察性队列研究的结果。
CMUH104 - REC2 - 115
