Reduction in mortality associated with statin therapy in patients with severe sepsis

Paul P Dobesh, Donald G Klepser, Timothy R McGuire, Craig W. Morgan, Keith M. Olsen

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

Study Objective. To evaluate the effect of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) on mortality in patients with severe sepsis. Design. Retrospective cohort study. Setting. Intensive care unit (ICU) of an academic medical center. Patients. One hundred eighty-eight patients aged 40 years or older with a diagnosis of severe sepsis and an ICU stay between January 1, 2005, and December 31, 2006. Measurements and Main Results. Patient demographic data, statin use, and Acute Physiology and Chronic Health Evaluation (APACHE) II scores at the time of sepsis diagnosis were collected from the patient database. We used a multivariable logistic regression model to evaluate the association between statin use and in-hospital all-cause mortality after controlling for age, sex, and severity of illness. Of the 188 patients who met our inclusion criteria, 60 (32%) had statin exposure. Patients receiving statins were similar in age, sex, and APACHE II scores to those not receiving statins. In the univariable comparison, the statin group had a 35% relative reduction in mortality compared with the nonstatin group (mortality rate 31.7% vs 48.4%, p=0.040). Most of the mortality reduction attributed to statins occurred in patients with APACHE II scores higher than 24 (mortality rate 32.3% vs 57.5%, p=0.031), with a minimal mortality difference in patients with APACHE II scores of 24 or lower (31% vs 36.4%, p=0.810). In the multivariable regression model, statin use had a protective effect (odds ratio [OR] 0.42, 95% confidence interval [CI] 0.21-0.84, p=0.014), whereas increasing age (OR 1.03, 95% CI 1.01-1.06, p=0.013) and higher APACHE II score (OR 1.11, 95% CI 1.05-1.18, p=0.001) were associated with increased mortality. Conclusion. The use of statins was associated with a protective effect in patients with severe sepsis, as demonstrated by a significant reduction in mortality compared with patients not receiving statins.

Original languageEnglish (US)
Pages (from-to)621-630
Number of pages10
JournalPharmacotherapy
Volume29
Issue number6
DOIs
StatePublished - Jun 1 2009

Fingerprint

Hydroxymethylglutaryl-CoA Reductase Inhibitors
Sepsis
Mortality
APACHE
Therapeutics
Odds Ratio
Confidence Intervals
Intensive Care Units
Logistic Models
Oxidoreductases
Cohort Studies
Retrospective Studies
Demography

Keywords

  • 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors
  • Critical care
  • ICU
  • Inflammation
  • Intensive care unit
  • Mortality
  • Sepsis
  • Statins

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

Reduction in mortality associated with statin therapy in patients with severe sepsis. / Dobesh, Paul P; Klepser, Donald G; McGuire, Timothy R; Morgan, Craig W.; Olsen, Keith M.

In: Pharmacotherapy, Vol. 29, No. 6, 01.06.2009, p. 621-630.

Research output: Contribution to journalArticle

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abstract = "Study Objective. To evaluate the effect of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) on mortality in patients with severe sepsis. Design. Retrospective cohort study. Setting. Intensive care unit (ICU) of an academic medical center. Patients. One hundred eighty-eight patients aged 40 years or older with a diagnosis of severe sepsis and an ICU stay between January 1, 2005, and December 31, 2006. Measurements and Main Results. Patient demographic data, statin use, and Acute Physiology and Chronic Health Evaluation (APACHE) II scores at the time of sepsis diagnosis were collected from the patient database. We used a multivariable logistic regression model to evaluate the association between statin use and in-hospital all-cause mortality after controlling for age, sex, and severity of illness. Of the 188 patients who met our inclusion criteria, 60 (32{\%}) had statin exposure. Patients receiving statins were similar in age, sex, and APACHE II scores to those not receiving statins. In the univariable comparison, the statin group had a 35{\%} relative reduction in mortality compared with the nonstatin group (mortality rate 31.7{\%} vs 48.4{\%}, p=0.040). Most of the mortality reduction attributed to statins occurred in patients with APACHE II scores higher than 24 (mortality rate 32.3{\%} vs 57.5{\%}, p=0.031), with a minimal mortality difference in patients with APACHE II scores of 24 or lower (31{\%} vs 36.4{\%}, p=0.810). In the multivariable regression model, statin use had a protective effect (odds ratio [OR] 0.42, 95{\%} confidence interval [CI] 0.21-0.84, p=0.014), whereas increasing age (OR 1.03, 95{\%} CI 1.01-1.06, p=0.013) and higher APACHE II score (OR 1.11, 95{\%} CI 1.05-1.18, p=0.001) were associated with increased mortality. Conclusion. The use of statins was associated with a protective effect in patients with severe sepsis, as demonstrated by a significant reduction in mortality compared with patients not receiving statins.",
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T1 - Reduction in mortality associated with statin therapy in patients with severe sepsis

AU - Dobesh, Paul P

AU - Klepser, Donald G

AU - McGuire, Timothy R

AU - Morgan, Craig W.

AU - Olsen, Keith M.

PY - 2009/6/1

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N2 - Study Objective. To evaluate the effect of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) on mortality in patients with severe sepsis. Design. Retrospective cohort study. Setting. Intensive care unit (ICU) of an academic medical center. Patients. One hundred eighty-eight patients aged 40 years or older with a diagnosis of severe sepsis and an ICU stay between January 1, 2005, and December 31, 2006. Measurements and Main Results. Patient demographic data, statin use, and Acute Physiology and Chronic Health Evaluation (APACHE) II scores at the time of sepsis diagnosis were collected from the patient database. We used a multivariable logistic regression model to evaluate the association between statin use and in-hospital all-cause mortality after controlling for age, sex, and severity of illness. Of the 188 patients who met our inclusion criteria, 60 (32%) had statin exposure. Patients receiving statins were similar in age, sex, and APACHE II scores to those not receiving statins. In the univariable comparison, the statin group had a 35% relative reduction in mortality compared with the nonstatin group (mortality rate 31.7% vs 48.4%, p=0.040). Most of the mortality reduction attributed to statins occurred in patients with APACHE II scores higher than 24 (mortality rate 32.3% vs 57.5%, p=0.031), with a minimal mortality difference in patients with APACHE II scores of 24 or lower (31% vs 36.4%, p=0.810). In the multivariable regression model, statin use had a protective effect (odds ratio [OR] 0.42, 95% confidence interval [CI] 0.21-0.84, p=0.014), whereas increasing age (OR 1.03, 95% CI 1.01-1.06, p=0.013) and higher APACHE II score (OR 1.11, 95% CI 1.05-1.18, p=0.001) were associated with increased mortality. Conclusion. The use of statins was associated with a protective effect in patients with severe sepsis, as demonstrated by a significant reduction in mortality compared with patients not receiving statins.

AB - Study Objective. To evaluate the effect of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) on mortality in patients with severe sepsis. Design. Retrospective cohort study. Setting. Intensive care unit (ICU) of an academic medical center. Patients. One hundred eighty-eight patients aged 40 years or older with a diagnosis of severe sepsis and an ICU stay between January 1, 2005, and December 31, 2006. Measurements and Main Results. Patient demographic data, statin use, and Acute Physiology and Chronic Health Evaluation (APACHE) II scores at the time of sepsis diagnosis were collected from the patient database. We used a multivariable logistic regression model to evaluate the association between statin use and in-hospital all-cause mortality after controlling for age, sex, and severity of illness. Of the 188 patients who met our inclusion criteria, 60 (32%) had statin exposure. Patients receiving statins were similar in age, sex, and APACHE II scores to those not receiving statins. In the univariable comparison, the statin group had a 35% relative reduction in mortality compared with the nonstatin group (mortality rate 31.7% vs 48.4%, p=0.040). Most of the mortality reduction attributed to statins occurred in patients with APACHE II scores higher than 24 (mortality rate 32.3% vs 57.5%, p=0.031), with a minimal mortality difference in patients with APACHE II scores of 24 or lower (31% vs 36.4%, p=0.810). In the multivariable regression model, statin use had a protective effect (odds ratio [OR] 0.42, 95% confidence interval [CI] 0.21-0.84, p=0.014), whereas increasing age (OR 1.03, 95% CI 1.01-1.06, p=0.013) and higher APACHE II score (OR 1.11, 95% CI 1.05-1.18, p=0.001) were associated with increased mortality. Conclusion. The use of statins was associated with a protective effect in patients with severe sepsis, as demonstrated by a significant reduction in mortality compared with patients not receiving statins.

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