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Sepsis outcomes in patients receiving statins prior to hospitalization for sepsis: comparison of in-hospital mortality rates between patients who received atorvastatin and those who received simvastatin.

Ouellette DR, Moscoso EE, Corrales JP, Peters M - Ann Intensive Care (2015)

Bottom Line: In-hospital mortality rates of patient subgroups receiving atorvastatin and simvastatin were also compared.The mortality rate for 92 patients who had received atorvastatin prior to hospitalization was significantly less than that of 253 patients who received simvastatin (18.5% versus 30.0%, p = 0.032).Pre-hospital atorvastatin use was associated with improved in-hospital mortality in septic patients when compared with pre-hospital simvastatin use and was independently associated with an improved outcome when compared to other sepsis risk factors.

View Article: PubMed Central - PubMed

Affiliation: Pulmonary and Critical Care Medicine, Henry Ford Hospital, K-17, 2799 West Grand Blvd, 48202 Detroit, MI USA.

ABSTRACT

Background: The purpose of this study is to compare the in-hospital mortality rates between septic patients receiving statins and those that did not prior to developing sepsis. We compared subgroups receiving atorvastatin and simvastatin because these two drugs differ in their pharmacologic properties.

Methods: This study was a retrospective analysis of patients selected from an institutional data base of patients hospitalized with sepsis. The study patients were drawn from a data base of 1,961 hospitalized patients with sepsis and included patients who met selection criteria and who were studied for HMG-CoA reductase inhibitor (statin) use both prior to and during hospitalization. The in-hospital mortality rates of patients receiving statins and those that did not prior to developing sepsis were compared. In-hospital mortality rates of patient subgroups receiving atorvastatin and simvastatin were also compared. A multivariable analysis was conducted with in-hospital mortality as the outcome variable and with multiple risk factors to include atorvastatin and simvastatin use.

Results: The mortality rate for 359 patients receiving statins prior to hospitalization for sepsis was not significantly different than that for 1,302 patients who did not receive pre-hospital statins (26.5% versus 30.4%, p > 0.05). The mortality rate for 92 patients who had received atorvastatin prior to hospitalization was significantly less than that of 253 patients who received simvastatin (18.5% versus 30.0%, p = 0.032). The use of atorvastatin prior to sepsis was independently associated with lower in-hospital mortality in a multivariable analysis of sepsis risk factors (p = 0.021, OR = 0.455). Patients who received atorvastatin prior to hospitalization for sepsis and had statins continued in hospital had a very low mortality rate that was significantly less than that of those patients who never received statins (15.7% versus 30.8%, p = 0.007).

Conclusions: Pre-hospital atorvastatin use was associated with improved in-hospital mortality in septic patients when compared with pre-hospital simvastatin use and was independently associated with an improved outcome when compared to other sepsis risk factors. The effect of statins in patients with sepsis may be different for individual statins.

No MeSH data available.


Related in: MedlinePlus

Organizational flowchart of patient episodes categorized by pre-hospital statin use and in-hospital mortality.
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Fig1: Organizational flowchart of patient episodes categorized by pre-hospital statin use and in-hospital mortality.

Mentions: Clinical data were collected in a data base of patients with sepsis for 1,965 patient episodes of sepsis between January 1, 2005, and December 31, 2010. From these patient episodes, we selected 1,661 patient episodes of sepsis for study based upon the criteria described in the ‘Methods’ section (Figure 1). Exclusions included subsequent patient episodes after the first in patients with multiple sepsis events (the majority) and those where demographic data was incomplete. Of these patients, 58% were transferred to the ICU from the emergency department, 12% were transferred to the ICU from a general medical or surgical ward, and 29% were active patients in the ICU when sepsis was diagnosed. Patients received initiation of sepsis care as soon as sepsis was identified, regardless of the venue of care. Of the 1,661 patient episodes investigated, 1,170 resulted in survival to hospital discharge while 491 led to in-hospital death from all causes, providing an overall in-hospital mortality rate of 29.6% for the investigated population (Figure 1). The mean age (±standard deviation) for the population was 63 (±17) years, and the mean APACHE II score (±standard deviation) was 19 (±7). Male patients (53%) outnumbered female patients in our population. Overall, 44.4% of patients received vasoactive agents to support blood pressure, and 48.4% of patients were intubated and received mechanical ventilation within the first 24 h of sepsis. The primary sources of infection are listed in Table 1.Figure 1


Sepsis outcomes in patients receiving statins prior to hospitalization for sepsis: comparison of in-hospital mortality rates between patients who received atorvastatin and those who received simvastatin.

Ouellette DR, Moscoso EE, Corrales JP, Peters M - Ann Intensive Care (2015)

Organizational flowchart of patient episodes categorized by pre-hospital statin use and in-hospital mortality.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4430500&req=5

Fig1: Organizational flowchart of patient episodes categorized by pre-hospital statin use and in-hospital mortality.
Mentions: Clinical data were collected in a data base of patients with sepsis for 1,965 patient episodes of sepsis between January 1, 2005, and December 31, 2010. From these patient episodes, we selected 1,661 patient episodes of sepsis for study based upon the criteria described in the ‘Methods’ section (Figure 1). Exclusions included subsequent patient episodes after the first in patients with multiple sepsis events (the majority) and those where demographic data was incomplete. Of these patients, 58% were transferred to the ICU from the emergency department, 12% were transferred to the ICU from a general medical or surgical ward, and 29% were active patients in the ICU when sepsis was diagnosed. Patients received initiation of sepsis care as soon as sepsis was identified, regardless of the venue of care. Of the 1,661 patient episodes investigated, 1,170 resulted in survival to hospital discharge while 491 led to in-hospital death from all causes, providing an overall in-hospital mortality rate of 29.6% for the investigated population (Figure 1). The mean age (±standard deviation) for the population was 63 (±17) years, and the mean APACHE II score (±standard deviation) was 19 (±7). Male patients (53%) outnumbered female patients in our population. Overall, 44.4% of patients received vasoactive agents to support blood pressure, and 48.4% of patients were intubated and received mechanical ventilation within the first 24 h of sepsis. The primary sources of infection are listed in Table 1.Figure 1

Bottom Line: In-hospital mortality rates of patient subgroups receiving atorvastatin and simvastatin were also compared.The mortality rate for 92 patients who had received atorvastatin prior to hospitalization was significantly less than that of 253 patients who received simvastatin (18.5% versus 30.0%, p = 0.032).Pre-hospital atorvastatin use was associated with improved in-hospital mortality in septic patients when compared with pre-hospital simvastatin use and was independently associated with an improved outcome when compared to other sepsis risk factors.

View Article: PubMed Central - PubMed

Affiliation: Pulmonary and Critical Care Medicine, Henry Ford Hospital, K-17, 2799 West Grand Blvd, 48202 Detroit, MI USA.

ABSTRACT

Background: The purpose of this study is to compare the in-hospital mortality rates between septic patients receiving statins and those that did not prior to developing sepsis. We compared subgroups receiving atorvastatin and simvastatin because these two drugs differ in their pharmacologic properties.

Methods: This study was a retrospective analysis of patients selected from an institutional data base of patients hospitalized with sepsis. The study patients were drawn from a data base of 1,961 hospitalized patients with sepsis and included patients who met selection criteria and who were studied for HMG-CoA reductase inhibitor (statin) use both prior to and during hospitalization. The in-hospital mortality rates of patients receiving statins and those that did not prior to developing sepsis were compared. In-hospital mortality rates of patient subgroups receiving atorvastatin and simvastatin were also compared. A multivariable analysis was conducted with in-hospital mortality as the outcome variable and with multiple risk factors to include atorvastatin and simvastatin use.

Results: The mortality rate for 359 patients receiving statins prior to hospitalization for sepsis was not significantly different than that for 1,302 patients who did not receive pre-hospital statins (26.5% versus 30.4%, p > 0.05). The mortality rate for 92 patients who had received atorvastatin prior to hospitalization was significantly less than that of 253 patients who received simvastatin (18.5% versus 30.0%, p = 0.032). The use of atorvastatin prior to sepsis was independently associated with lower in-hospital mortality in a multivariable analysis of sepsis risk factors (p = 0.021, OR = 0.455). Patients who received atorvastatin prior to hospitalization for sepsis and had statins continued in hospital had a very low mortality rate that was significantly less than that of those patients who never received statins (15.7% versus 30.8%, p = 0.007).

Conclusions: Pre-hospital atorvastatin use was associated with improved in-hospital mortality in septic patients when compared with pre-hospital simvastatin use and was independently associated with an improved outcome when compared to other sepsis risk factors. The effect of statins in patients with sepsis may be different for individual statins.

No MeSH data available.


Related in: MedlinePlus