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Impact of statin therapy on mortality in patients with sepsis-associated acute respiratory distress syndrome (ARDS) depends on ARDS severity: a prospective observational cohort study.

Mansur A, Steinau M, Popov AF, Ghadimi M, Beissbarth T, Bauer M, Hinz J - BMC Med (2015)

Bottom Line: To exclude the effects of several confounders, we performed multivariate Cox regression analysis, which showed that statin therapy remained a significant covariate for mortality (hazard ratio, 5.46; 95 % CI, 1.38-21.70; P = 0.0156).This investigation suggests a beneficial effect of continuous statin therapy in patients with severe sepsis-associated ARDS and a history of prior statin therapy.Further study is warranted to elucidate this potential effect.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, University Medical Center, Georg August University, D-37075, Goettingen, Germany. ashham.mansur@med.uni-goettingen.de.

ABSTRACT

Background: Previous investigations have presumed a potential therapeutic effect of statin therapy in patients with acute respiratory distress syndrome (ARDS). Statins are expected to attenuate inflammation in the lungs of patients with ARDS due to their anti-inflammatory effects. Clinical investigations of the role of statin therapy have revealed contradictory results. This study aimed to investigate whether pretreatment and continuous therapy with statins in patients with sepsis-associated ARDS are associated with 28-day survival according to disease severity (mild, moderate, or severe).

Methods: Patients with sepsis-associated ARDS from the surgical intensive care were enrolled in this prospective observational investigation. ARDS was classified into three groups (mild, moderate, and severe); 28-day mortality was recorded as the primary outcome variable and organ failure was recorded as secondary outcome variable. Sequential Organ Failure Assessment scores and the requirements for organ support were evaluated throughout the observational period to assess organ failure.

Results: 404 patients with sepsis-associated ARDS were enrolled in this investigation. The distribution of the ARDS subgroups was 13 %, 59 %, and 28 % for mild, moderate, and severe disease, respectively. Statin therapy improved 28-day survival exclusively in the patients with severe ARDS compared with patients without statin therapy (88.5 % and 62.5 %, respectively; P = 0.0193). To exclude the effects of several confounders, we performed multivariate Cox regression analysis, which showed that statin therapy remained a significant covariate for mortality (hazard ratio, 5.46; 95 % CI, 1.38-21.70; P = 0.0156). Moreover, after carrying a propensity score-matching in the severe ARDS cohort, Kaplan-Meier survival analysis confirmed the improved 28-day survival among patients with statin therapy (P = 0.0205). Patients with severe ARDS who received statin therapy had significantly more vasopressor-free days compared with those without statin therapy (13 ± 7 and 9 ± 7, respectively; P = 0.0034), and they also required less extracorporeal membrane oxygenation (ECMO) therapy and had more ECMO-free days (18 ± 9 and 15 ± 9, respectively; P = 0.0873).

Conclusions: This investigation suggests a beneficial effect of continuous statin therapy in patients with severe sepsis-associated ARDS and a history of prior statin therapy. Further study is warranted to elucidate this potential effect.

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Related in: MedlinePlus

Kaplan-Meier survival analysis of 28-day survival according to statin therapy for the three acute respiratory distress syndrome (ARDS) groups. The Kaplan-Meier survival curves censored at day 28 for each ARDS group (mild, moderate, and severe) according to the presence of statin therapy. Treatment with statins only significantly impacted 28-day survival among the patients with severe sepsis-associated ARDS (P = 0.0193, log-rank test)
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Fig3: Kaplan-Meier survival analysis of 28-day survival according to statin therapy for the three acute respiratory distress syndrome (ARDS) groups. The Kaplan-Meier survival curves censored at day 28 for each ARDS group (mild, moderate, and severe) according to the presence of statin therapy. Treatment with statins only significantly impacted 28-day survival among the patients with severe sepsis-associated ARDS (P = 0.0193, log-rank test)

Mentions: Furthermore, to detect the impact of statin therapy on the outcome of sepsis-associated ARDS and its dependency on disease severity (mild, moderate, or severe), Kaplan-Meier survival analysis (mean outcome parameter) was performed to assess 28-day survival for these three groups of patients (Fig. 3). Treatment with statins significantly impacted the 28-day survival exclusively among the patients with severe sepsis-associated ARDS. Those with severe ARDS who were on statin therapy had a lower 28-day mortality rate compared with those who were not on this therapy (11.5 % and 37.5 %, respectively; P = 0.0193; Fig. 3). After performing propensity score matching, survival analysis remained significant with a marginal change (P = 0.0205 (after propensity score matching) vs. P = 0.0193 (without propensity score matching); Fig. 4). There were no differences in the 28-day mortality risk between the patients with statin therapy and those without therapy in the mild and moderate sepsis-associated ARDS groups (Fig. 3).Fig. 3


Impact of statin therapy on mortality in patients with sepsis-associated acute respiratory distress syndrome (ARDS) depends on ARDS severity: a prospective observational cohort study.

Mansur A, Steinau M, Popov AF, Ghadimi M, Beissbarth T, Bauer M, Hinz J - BMC Med (2015)

Kaplan-Meier survival analysis of 28-day survival according to statin therapy for the three acute respiratory distress syndrome (ARDS) groups. The Kaplan-Meier survival curves censored at day 28 for each ARDS group (mild, moderate, and severe) according to the presence of statin therapy. Treatment with statins only significantly impacted 28-day survival among the patients with severe sepsis-associated ARDS (P = 0.0193, log-rank test)
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4462111&req=5

Fig3: Kaplan-Meier survival analysis of 28-day survival according to statin therapy for the three acute respiratory distress syndrome (ARDS) groups. The Kaplan-Meier survival curves censored at day 28 for each ARDS group (mild, moderate, and severe) according to the presence of statin therapy. Treatment with statins only significantly impacted 28-day survival among the patients with severe sepsis-associated ARDS (P = 0.0193, log-rank test)
Mentions: Furthermore, to detect the impact of statin therapy on the outcome of sepsis-associated ARDS and its dependency on disease severity (mild, moderate, or severe), Kaplan-Meier survival analysis (mean outcome parameter) was performed to assess 28-day survival for these three groups of patients (Fig. 3). Treatment with statins significantly impacted the 28-day survival exclusively among the patients with severe sepsis-associated ARDS. Those with severe ARDS who were on statin therapy had a lower 28-day mortality rate compared with those who were not on this therapy (11.5 % and 37.5 %, respectively; P = 0.0193; Fig. 3). After performing propensity score matching, survival analysis remained significant with a marginal change (P = 0.0205 (after propensity score matching) vs. P = 0.0193 (without propensity score matching); Fig. 4). There were no differences in the 28-day mortality risk between the patients with statin therapy and those without therapy in the mild and moderate sepsis-associated ARDS groups (Fig. 3).Fig. 3

Bottom Line: To exclude the effects of several confounders, we performed multivariate Cox regression analysis, which showed that statin therapy remained a significant covariate for mortality (hazard ratio, 5.46; 95 % CI, 1.38-21.70; P = 0.0156).This investigation suggests a beneficial effect of continuous statin therapy in patients with severe sepsis-associated ARDS and a history of prior statin therapy.Further study is warranted to elucidate this potential effect.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, University Medical Center, Georg August University, D-37075, Goettingen, Germany. ashham.mansur@med.uni-goettingen.de.

ABSTRACT

Background: Previous investigations have presumed a potential therapeutic effect of statin therapy in patients with acute respiratory distress syndrome (ARDS). Statins are expected to attenuate inflammation in the lungs of patients with ARDS due to their anti-inflammatory effects. Clinical investigations of the role of statin therapy have revealed contradictory results. This study aimed to investigate whether pretreatment and continuous therapy with statins in patients with sepsis-associated ARDS are associated with 28-day survival according to disease severity (mild, moderate, or severe).

Methods: Patients with sepsis-associated ARDS from the surgical intensive care were enrolled in this prospective observational investigation. ARDS was classified into three groups (mild, moderate, and severe); 28-day mortality was recorded as the primary outcome variable and organ failure was recorded as secondary outcome variable. Sequential Organ Failure Assessment scores and the requirements for organ support were evaluated throughout the observational period to assess organ failure.

Results: 404 patients with sepsis-associated ARDS were enrolled in this investigation. The distribution of the ARDS subgroups was 13 %, 59 %, and 28 % for mild, moderate, and severe disease, respectively. Statin therapy improved 28-day survival exclusively in the patients with severe ARDS compared with patients without statin therapy (88.5 % and 62.5 %, respectively; P = 0.0193). To exclude the effects of several confounders, we performed multivariate Cox regression analysis, which showed that statin therapy remained a significant covariate for mortality (hazard ratio, 5.46; 95 % CI, 1.38-21.70; P = 0.0156). Moreover, after carrying a propensity score-matching in the severe ARDS cohort, Kaplan-Meier survival analysis confirmed the improved 28-day survival among patients with statin therapy (P = 0.0205). Patients with severe ARDS who received statin therapy had significantly more vasopressor-free days compared with those without statin therapy (13 ± 7 and 9 ± 7, respectively; P = 0.0034), and they also required less extracorporeal membrane oxygenation (ECMO) therapy and had more ECMO-free days (18 ± 9 and 15 ± 9, respectively; P = 0.0873).

Conclusions: This investigation suggests a beneficial effect of continuous statin therapy in patients with severe sepsis-associated ARDS and a history of prior statin therapy. Further study is warranted to elucidate this potential effect.

Show MeSH
Related in: MedlinePlus