Liu Yuan, Chen Jijiang, Yuan Yehao, Niu Pingping, Wu Mengyi, Shang Baoling, Lu Weihui, Zou Xu, Yao Gengzhen
Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China.
The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.
Front Pharmacol. 2025 Mar 19;16:1520107. doi: 10.3389/fphar.2025.1520107. eCollection 2025.
Sepsis-induced myocardial injury (SIMI) is a critical complication of sepsis, marked by high mortality rates, and lacks effective treatments. The impact of statin therapy on mortality in SIMI patients remains unclear. This study aims to explore the association between statin use and mortality in SIMI patients, focusing on both short-term and long-term outcomes.
A retrospective cohort study was conducted by extracting SIMI patient information from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Patients were categorized into statin and non-statin groups. A 1:1 nearest propensity-score matching (PSM) was used to balance baseline characteristics. Survival outcomes were assessed using Kaplan-Meier analysis and robust Cox proportional hazards models to understand the effects of statin use, type and dosage on mortality at 28 days, 90 days, and 1 year. E-Value analysis was used for unmeasured confounding.
A total of 2,246 patients meeting SIMI criteria were enrolled in the final cohort, with 17.9% receiving statins during their ICU stay. Statin use was associated with significantly lower mortality at all time points, as shown by Kaplan-Meier analysis. In multivariable robust Cox regression models, statin therapy correlated with a 32% reduction in 28-day mortality (HR = 0.68, 95% CI: 0.49-0.94), a 29% reduction at 90 days (HR = 0.71, 95% CI: 0.54-0.93), and a 28% reduction at 1 year (HR = 0.72, 95% CI: 0.58-0.90), maintaining significance after adjustment for confounders. Simvastatin was particularly effective, and low-dose statins were linked to reduced mortality risk. Subgroup analyses suggested consistent statin benefits. E-Value analysis suggested robustness to unmeasured confounding.
Our study demonstrates that statin use is significantly associated with reduced mortality in SIMI patients across 28 days, 90 days, and 1 year. Simvastatin provides substantial benefits, with low-dose statins providing greater advantages compared to high-dose formulations.
脓毒症诱导的心肌损伤（SIMI）是脓毒症的一种关键并发症，死亡率高，且缺乏有效治疗方法。他汀类药物治疗对SIMI患者死亡率的影响仍不明确。本研究旨在探讨他汀类药物使用与SIMI患者死亡率之间的关联，重点关注短期和长期结局。
通过从重症监护医学信息数据库IV（MIMIC-IV）中提取SIMI患者信息进行回顾性队列研究。将患者分为他汀类药物组和非他汀类药物组。采用1:1最近邻倾向评分匹配（PSM）来平衡基线特征。使用Kaplan-Meier分析和稳健的Cox比例风险模型评估生存结局，以了解他汀类药物使用、类型和剂量对28天、90天和1年死亡率的影响。采用E值分析来评估未测量的混杂因素。
最终队列共纳入2246例符合SIMI标准的患者，其中17.9%在重症监护病房住院期间接受了他汀类药物治疗。Kaplan-Meier分析显示，使用他汀类药物在所有时间点的死亡率均显著降低。在多变量稳健Cox回归模型中，他汀类药物治疗与28天死亡率降低32%相关（HR = 0.68，95% CI：0.49-0.94），90天降低29%（HR = 0.71，95% CI：0.54-0.93），1年降低28%（HR = 0.72，95% CI：0.58-0.90），在调整混杂因素后仍具有显著性。辛伐他汀特别有效，低剂量他汀类药物与降低死亡风险相关。亚组分析表明他汀类药物的益处具有一致性。E值分析表明对未测量的混杂因素具有稳健性。
我们的研究表明，使用他汀类药物与SIMI患者在28天、90天和1年时死亡率降低显著相关。辛伐他汀提供了显著益处，与高剂量制剂相比，低剂量他汀类药物具有更大优势。
