入院前使用他汀类药物与危重症患者 90 天死亡率的相关性：一项回顾性关联研究。

Preadmission Statin Use and 90-day Mortality in the Critically Ill: A Retrospective Association Study.

机构信息

From the Department of Anesthesiology and Pain Medicine (T.K.O., I.-A.S., Y.-T.J.) the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (J.H.L.) the Department of Thoracic and Cardiovascular Surgery (C.L.) the Department of Neurology, Stroke Center (H.-J.B.) the Department of Emergency Medicine (Y.H.J.), Seoul National University Bundang Hospital, Seongnam, Korea the Department of Biostatistics, Korea University College of Medicine, Seoul, Korea (H.-J.J.).

出版信息

Anesthesiology. 2019 Aug;131(2):315-327. doi: 10.1097/ALN.0000000000002811.

DOI:10.1097/ALN.0000000000002811

PMID:31246609

Abstract

BACKGROUND

This study aimed to examine the association between preadmission statin use and 90-day mortality in critically ill patients and to investigate whether this association differed according to statin type and dose. We hypothesized that preadmission statin use was associated with lower 90-day mortality.

METHODS

This retrospective cohort study analyzed the medical records of all adult patients admitted to the intensive care unit in a single tertiary academic hospital between January 2012 and December 2017. Data including preadmission statin use, statin subtype, and daily dosage were collected, and the associations between these variables and 90-day mortality after intensive care unit admission were examined. The primary endpoint was 90-day mortality.

RESULTS

A total of 24,928 patients (7,396 statin users and 17,532 non-statin users) were included. After propensity score matching, 5,354 statin users and 7,758 non-statin users were finally included. The 90-day mortality rate was significantly higher in non-statin users (918 of 7,758; 11.8%) than in statin users (455 of 5,354; 8.5%; P < 0.001). In Cox regression analysis, the 90-day mortality rate was lower among statin users than among non-statin users (hazard ratio: 0.70, 95% CI: 0.63 to 0.79; P < 0.001). Rosuvastatin use was associated with 42% lower 90-day mortality (hazard ratio: 0.58, 95% CI: 0.47 to 0.72; P < 0.001). There were no specific significant differences in the association between daily statin dose and 90-day mortality. In competing risk analysis, the risk of noncardiovascular 90-day mortality in statin users was 32% lower than that in non-statin users (hazard ratio: 0.68, 95% CI: 0.60 to 0.78; P < 0.001). Meanwhile, cardiovascular 90-day mortality was not significantly associated with statin use.

CONCLUSIONS

Preadmission statin use was associated with a lower 90-day mortality. This association was more evident in the rosuvastatin group and with noncardiovascular 90-day mortality; no differences were seen according to daily dosage intensity.

摘要

背景

本研究旨在探讨重症患者入院前使用他汀类药物与 90 天死亡率之间的关系，并探讨这种关系是否因他汀类药物的类型和剂量而异。我们假设入院前使用他汀类药物与较低的 90 天死亡率相关。

方法

本回顾性队列研究分析了 2012 年 1 月至 2017 年 12 月期间在一家三级学术医院重症监护病房住院的所有成年患者的病历。收集了入院前使用他汀类药物、他汀类药物亚型和每日剂量等数据，并研究了这些变量与重症监护病房入院后 90 天死亡率之间的关系。主要终点为 90 天死亡率。

结果

共纳入 24928 例患者（7396 例他汀类药物使用者和 17532 例非他汀类药物使用者）。经过倾向评分匹配后，最终纳入 5354 例他汀类药物使用者和 7758 例非他汀类药物使用者。非他汀类药物使用者（7758 例中的 918 例，11.8%）的 90 天死亡率明显高于他汀类药物使用者（5354 例中的 455 例，8.5%；P<0.001）。在 Cox 回归分析中，他汀类药物使用者的 90 天死亡率低于非他汀类药物使用者（风险比：0.70，95%CI：0.63 至 0.79；P<0.001）。使用瑞舒伐他汀可使 90 天死亡率降低 42%（风险比：0.58，95%CI：0.47 至 0.72；P<0.001）。他汀类药物每日剂量与 90 天死亡率之间无特定显著关联。在竞争风险分析中，他汀类药物使用者非心血管 90 天死亡率的风险比非他汀类药物使用者低 32%（风险比：0.68，95%CI：0.60 至 0.78；P<0.001）。同时，心血管 90 天死亡率与他汀类药物使用无显著关联。