Oh Tak Kyu, Song In-Ae, Choi Sunkyu
Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Korea.
Ann Transl Med. 2020 Mar;8(6):396. doi: 10.21037/atm.2020.02.101.
The effect of prior statin exposure in critically ill patients remains controversial and has not been established in previous cohort studies. We performed a systematic review of previous cohort studies to evaluate the association of prior statin therapy with mortality in critically ill patients and conducted a meta-analysis. The MEDLINE, EMBASE, and Cochrane CENTRAL databases, from their inception to January 7, 2020, were used for this study. Statin users were defined as patients prescribed statin regularly before intensive care unit admission or diagnosis of a specific disease, such as sepsis. The Cochran chi-square test and I statistics were used to determine heterogeneity between studies. In total, 199,985 critically ill patients from nine studies (44,582 statin users and 155,403 non-statin users) were included in the meta-analysis. According to the random effect model, the 30-day mortality of statin users was 31% lower than that of non-statin users (hazard ratio: 0.69, 95% confidence interval: 0.56 to 0.85). This association was similar in atorvastatin users and simvastatin users. However, hospital mortality in statin users was not significantly associated with that in non-statin users [odds ratios (ORs): 0.71, 95% CI: 0.42 to 1.21]. This study showed that there was a beneficial association of prior statin therapy with 30-day mortality in critically ill patients. However, there was no significant association with hospital mortality. Additional prospective cohort studies with a large sample size should be performed to confirm these findings.
既往他汀类药物暴露对重症患者的影响仍存在争议，且此前的队列研究尚未明确。我们对既往队列研究进行了系统综述，以评估既往他汀类药物治疗与重症患者死亡率之间的关联，并进行了荟萃分析。本研究使用了MEDLINE、EMBASE和Cochrane CENTRAL数据库，检索时间从各数据库建库至2020年1月7日。他汀类药物使用者定义为在重症监护病房入院前或诊断出特定疾病（如脓毒症）之前定期服用他汀类药物的患者。采用Cochran卡方检验和I统计量来确定研究之间的异质性。荟萃分析共纳入了9项研究中的199,985例重症患者（44,582例他汀类药物使用者和155,403例非他汀类药物使用者）。根据随机效应模型，他汀类药物使用者的30天死亡率比非他汀类药物使用者低31%（风险比：0.69，95%置信区间：0.56至0.85）。阿托伐他汀使用者和辛伐他汀使用者之间的这种关联相似。然而，他汀类药物使用者的医院死亡率与非他汀类药物使用者的医院死亡率无显著关联[优势比（OR）：0.71，95%置信区间：0.42至1.21]。本研究表明，既往他汀类药物治疗与重症患者的30天死亡率存在有益关联。然而，与医院死亡率无显著关联。应开展更多大样本的前瞻性队列研究以证实这些发现。
