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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

Comparison of in-hospital mortality between patient cohorts. *Pre-hospital atorvastatin vs pre-hospital simvastatin, p value = 0.032 (chi-square); pre-hospital atorvastatin vs no pre-hospital statin, p = 0.015 (chi-square).
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Fig2: Comparison of in-hospital mortality between patient cohorts. *Pre-hospital atorvastatin vs pre-hospital simvastatin, p value = 0.032 (chi-square); pre-hospital atorvastatin vs no pre-hospital statin, p = 0.015 (chi-square).

Mentions: There were 359 patients who received statins prior to hospitalization for sepsis. The in-hospital mortality rate for patients who received pre-hospital statins was not significantly different from the mortality rate for those patients not receiving pre-hospital statins (26.5% versus 30.4%, p = 0.146, Figure 2). We chose to compare the group of patients receiving pre-hospital atorvastatin to those receiving simvastatin. The demographic and clinical characteristics of these two groups were very similar (Table 2). Among the patients who received pre-hospital statins, 92 patients received atorvastatin, while 253 received simvastatin (Figure 1). Seventeen patients receiving pre-hospital atorvastatin died (18.5%), compared with 76 in the simvastatin group (30.0%), a difference which achieved statistical significance (p = 0.032, Figure 2). The atorvastatin group also had a significantly lower mortality rate than did those patients not receiving pre-hospital statins (n = 1,302, mortality rate = 30.4%, p = 0.015). We had dosing information available for all patients receiving pre-hospital simvastatin and atorvastatin. The mortality difference between groups of patients receiving different doses of simvastatin, or between these groups and the population of patients who did not receive pre-hospital statins, did not achieve significance. For atorvastatin, 5 of the 13 patients prescribed 10 mg of atorvastatin daily died, providing a mortality rate of 38.5%, which compares unfavorably with that of the 79 patients receiving higher doses of atorvastatin (15.2%, p = 0.045).Figure 2


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)

Comparison of in-hospital mortality between patient cohorts. *Pre-hospital atorvastatin vs pre-hospital simvastatin, p value = 0.032 (chi-square); pre-hospital atorvastatin vs no pre-hospital statin, p = 0.015 (chi-square).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: Comparison of in-hospital mortality between patient cohorts. *Pre-hospital atorvastatin vs pre-hospital simvastatin, p value = 0.032 (chi-square); pre-hospital atorvastatin vs no pre-hospital statin, p = 0.015 (chi-square).
Mentions: There were 359 patients who received statins prior to hospitalization for sepsis. The in-hospital mortality rate for patients who received pre-hospital statins was not significantly different from the mortality rate for those patients not receiving pre-hospital statins (26.5% versus 30.4%, p = 0.146, Figure 2). We chose to compare the group of patients receiving pre-hospital atorvastatin to those receiving simvastatin. The demographic and clinical characteristics of these two groups were very similar (Table 2). Among the patients who received pre-hospital statins, 92 patients received atorvastatin, while 253 received simvastatin (Figure 1). Seventeen patients receiving pre-hospital atorvastatin died (18.5%), compared with 76 in the simvastatin group (30.0%), a difference which achieved statistical significance (p = 0.032, Figure 2). The atorvastatin group also had a significantly lower mortality rate than did those patients not receiving pre-hospital statins (n = 1,302, mortality rate = 30.4%, p = 0.015). We had dosing information available for all patients receiving pre-hospital simvastatin and atorvastatin. The mortality difference between groups of patients receiving different doses of simvastatin, or between these groups and the population of patients who did not receive pre-hospital statins, did not achieve significance. For atorvastatin, 5 of the 13 patients prescribed 10 mg of atorvastatin daily died, providing a mortality rate of 38.5%, which compares unfavorably with that of the 79 patients receiving higher doses of atorvastatin (15.2%, p = 0.045).Figure 2

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