Rafael Fernandez1, Victor Jose De Pedro, Antonio Artigas. 1. Critical Care Center, Hospital de Sabadell, Institut Universitari Parc Tauli, Universitat Autonoma de Barcelona, Parc Taulí s/n, 08208 Sabadell, Spain. rfernandez@cspt.es
Abstract
OBJECTIVE: Examine the impact of previous statin therapy on hospital mortality and whether it is due to a protective effect against ICU-acquired infections. DESIGN AND SETTING: Cohort comparison study by retrospective chart-based analysis in a 26-bed, university-affiliated, medical-surgical ICU. PATIENTS: We analyzed data from 438 patients at high risk of ICU-acquired infections, i.e., those receiving mechanical ventilation for more than 96 h, 38 (8.7%) of whom had been treated with statins prior to and during ICU admission. MEASUREMENTS AND RESULTS: We recorded clinical characteristics, number and type of ICU-acquired infections, and ICU and hospital mortality. Statin-treated patients were older (71.7+/-8.3 vs. 61.5+/-18.3 years), but differences in predicted mortality risk by APACHE II (39.5+/-24.7 vs. 35.8+/-24.3%) did not reach statistical significance. The ICU-acquired infection rate in statin-treated patients was nonsignificantly lower (29% vs. 38%) and delayed (median 12 vs.10 days), without differences regarding the source of infections. Nevertheless, hospital mortality was significantly higher in statin-treated patients (61% vs. 42%), even after adjustment for APACHE II predicted risk (observed/expected ratio 1.53 vs. 1.17). CONCLUSIONS: Statin therapy is associated with worse outcome, probably because underlying clinical conditions are insufficiently considered in mortality predictors. Its presumed protective effect against ICU infections remains unconfirmed.
OBJECTIVE: Examine the impact of previous statin therapy on hospital mortality and whether it is due to a protective effect against ICU-acquired infections. DESIGN AND SETTING: Cohort comparison study by retrospective chart-based analysis in a 26-bed, university-affiliated, medical-surgical ICU. PATIENTS: We analyzed data from 438 patients at high risk of ICU-acquired infections, i.e., those receiving mechanical ventilation for more than 96 h, 38 (8.7%) of whom had been treated with statins prior to and during ICU admission. MEASUREMENTS AND RESULTS: We recorded clinical characteristics, number and type of ICU-acquired infections, and ICU and hospital mortality. Statin-treated patients were older (71.7+/-8.3 vs. 61.5+/-18.3 years), but differences in predicted mortality risk by APACHE II (39.5+/-24.7 vs. 35.8+/-24.3%) did not reach statistical significance. The ICU-acquired infection rate in statin-treated patients was nonsignificantly lower (29% vs. 38%) and delayed (median 12 vs.10 days), without differences regarding the source of infections. Nevertheless, hospital mortality was significantly higher in statin-treated patients (61% vs. 42%), even after adjustment for APACHE II predicted risk (observed/expected ratio 1.53 vs. 1.17). CONCLUSIONS: Statin therapy is associated with worse outcome, probably because underlying clinical conditions are insufficiently considered in mortality predictors. Its presumed protective effect against ICU infections remains unconfirmed.
Authors: C P Sparrow; C A Burton; M Hernandez; S Mundt; H Hassing; S Patel; R Rosa; A Hermanowski-Vosatka; P R Wang; D Zhang; L Peterson; P A Detmers; Y S Chao; S D Wright Journal: Arterioscler Thromb Vasc Biol Date: 2001-01 Impact factor: 8.311
Authors: David W McCarey; Iain B McInnes; Rajan Madhok; Rosie Hampson; Olga Scherbakov; Ian Ford; Hilary A Capell; Naveed Sattar Journal: Lancet Date: 2004-06-19 Impact factor: 79.321
Authors: Gustavo del Real; Sonia Jiménez-Baranda; Emilia Mira; Rosa Ana Lacalle; Pilar Lucas; Concepción Gómez-Moutón; Marta Alegret; Jose María Peña; Manuel Rodríguez-Zapata; Melchor Alvarez-Mon; Carlos Martínez-A; Santos Mañes Journal: J Exp Med Date: 2004-08-16 Impact factor: 14.307
Authors: John P Magulick; Christopher R Frei; Sayed K Ali; Eric M Mortensen; Mary Jo Pugh; Christine U Oramasionwu; Kelly R Daniels; Ishak A Mansi Journal: Am J Med Sci Date: 2014-03 Impact factor: 2.378
Authors: Daryl J Kor; Remzi Iscimen; Murat Yilmaz; Michael J Brown; Daniel R Brown; Ognjen Gajic Journal: Intensive Care Med Date: 2009-01-31 Impact factor: 17.440
Authors: Kelly Lima Calisto; Bruno de Melo Carvalho; Eduardo Rochete Ropelle; Francine Cappa Mittestainer; Angélica Costa Aranha Camacho; Dioze Guadagnini; José Barreto Campelo Carvalheira; Mario José Abdalla Saad Journal: PLoS One Date: 2010-12-06 Impact factor: 3.240
Authors: Steffen Christensen; Reimar W Thomsen; Martin B Johansen; Lars Pedersen; Reinhold Jensen; Kim M Larsen; Anders Larsson; Else Tønnesen; Henrik Toft Sørensen Journal: Crit Care Date: 2010-03-09 Impact factor: 9.097