Vahedian-Azimi Amir, Beni Farshad Heidari, Fras Zlatko, Banach Maciej, Mohammadi Seyede Momeneh, Jamialahmadi Tannaz, Sahebkar Amirhossein
Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran.
Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
Arch Med Sci. 2023 Jan 27;19(4):952-964. doi: 10.5114/aoms/159992. eCollection 2023.
In critically ill patients, acute kidney injury (AKI) is a common complication with very high mortality rates. Several studies indicated that statin therapy, primarily due to its so-called pleiotropic effects, may beneficially affect the course of the disease, otherwise leading to significant clinical complications. However, both the original research as well as available meta-analyses on these associations report equivocal results. This leaves open a question whether pre- and perioperative statins might prevent AKI and improve overall prognosis in patients undergoing surgery.
Following a systematic search of the literature, we performed a meta-analysis of selected clinical studies investigating the impact of statin treatment on the development and the clinical outcomes of AKI among subjects undergoing surgeries. The pooled odds ratios (OR) with 95% confidence intervals (CI) for the development of AKI and AKI-associated mortality, as well as the pooled mean differences (MD) and 95% CI for mean intensive care unit (ICU) stay and overall hospital length of stay were calculated for statin users compared to non-users.
Our results showed a highly significant association between statin use and the decrease in mortality of patients with AKI (OR = 0.73, 95% CI: 0.69-0.77; p<0.001). The development of AKI (OR = 0.92, 95% CI: 0.63-1.33; = 0.659) as well as the ICU stay (MD = -0.02, 95% CI: -0.06 - 0.02; = 0.321) were not significantly affected, while the overall hospital length of stay (MD = -0.49, 95% CI: -0.91 -0.07; = 0.020) was reduced. Subgroup analysis showed that both pre- and postoperative statin use were not associated with the risk of AKI.
Our analysis showed a significant association between statin therapy and overall mortality of critically ill surgical patients diagnosed with AKI, while at the same time the use of statins did not affect the length of their stay in ICU.
在危重症患者中，急性肾损伤（AKI）是一种常见并发症，死亡率极高。多项研究表明，他汀类药物治疗主要因其所谓的多效性作用，可能对疾病进程产生有益影响，否则会导致严重的临床并发症。然而，关于这些关联的原始研究以及现有的荟萃分析均报告了不明确的结果。这就留下了一个问题，即术前和围手术期使用他汀类药物是否可以预防接受手术患者发生AKI并改善总体预后。
在对文献进行系统检索后，我们对选定的临床研究进行了荟萃分析，这些研究调查了他汀类药物治疗对接受手术患者中AKI的发生及临床结局的影响。计算了他汀类药物使用者与非使用者相比，发生AKI和AKI相关死亡率的合并比值比（OR）及95%置信区间（CI），以及重症监护病房（ICU）平均住院时间和总体住院时间的合并均值差（MD）及95%CI。
我们的结果显示，他汀类药物使用与AKI患者死亡率降低之间存在高度显著的关联（OR = 0.73，95%CI：0.69 - 0.77；p < 0.001）。AKI的发生（OR = 0.92，95%CI：0.63 - 1.33；p = 0.659）以及ICU住院时间（MD = -0.02，95%CI：-0.06 - 0.02；p = 0.321）未受到显著影响，而总体住院时间缩短（MD = -0.49，95%CI：-0.91 - 0.07；p = 0.020）。亚组分析表明，术前和术后使用他汀类药物均与AKI风险无关。
我们的分析表明，他汀类药物治疗与诊断为AKI的危重症手术患者的总体死亡率之间存在显著关联，同时他汀类药物的使用并未影响其在ICU的住院时间。
