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.
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.
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DOI：
10.1186/s12916-015-0368-6
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发表时间：
2015-06-01
期刊：
影响因子：
9.3
通讯作者：
Hinz J
中科院分区：
文献类型：
--
作者：
Mansur A;Steinau M;Popov AF;Ghadimi M;Beissbarth T;Bauer M;Hinz J
以前的研究已经推测他汀类药物治疗急性呼吸窘迫综合征（ARDS）患者的潜在治疗效果。由于他汀类药物的抗炎作用，预期他汀类药物可减轻ARDS患者肺部的炎症。他汀类药物治疗作用的临床研究显示了相互矛盾的结果。本研究旨在根据疾病严重程度（轻度、中度或重度），调查脓毒症相关ARDS患者接受他汀类药物预处理和持续治疗是否与28天生存率相关。本前瞻性观察性研究纳入了外科重症监护病房的脓毒症相关ARDS患者。ARDS分为三组（轻度、中度和重度）; 28天死亡率记录为主要结局变量，器官衰竭记录为次要结局变量。在整个观察期间评价序贯器官衰竭评估评分和器官支持要求，以评估器官衰竭。404例脓毒症相关ARDS患者入组本研究。轻度、中度和重度疾病的ARDS亚组分布分别为13%、59%和28%。与未接受他汀类药物治疗的患者相比，他汀类药物治疗仅改善了重度ARDS患者的28天生存率（分别为88.5%和62.5%; P = 0.0193）。为了排除几个混杂因素的影响，我们进行了多变量考克斯回归分析，结果显示他汀类药物治疗仍然是死亡率的重要协变量（风险比，5. 46; 95% CI，1. 38 - 21. 70; P = 0. 0156）。此外，在重度ARDS队列中进行倾向评分匹配后，Kaplan-Meier生存分析证实了他汀类药物治疗患者的28天生存率提高（P = 0.0205）。与未接受他汀类药物治疗的患者相比，接受他汀类药物治疗的重度ARDS患者的无血管加压药天数显著更多（分别为13 ± 7和9 ± 7; P = 0.0034），他们还需要更少的体外膜肺氧合（ECMO）治疗，无ECMO天数更多（分别为18 ± 9和15 ± 9; P = 0.0873）。这项研究表明，持续他汀类药物治疗对有他汀类药物治疗史的严重脓毒症相关ARDS患者有有益作用。进一步的研究是必要的，以阐明这种潜在的影响。本文的在线版本（doi：10.1186/s12916-015-0368-6）包含补充材料，可供授权用户使用。
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). 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. 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). 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. The online version of this article (doi:10.1186/s12916-015-0368-6) contains supplementary material, which is available to authorized users.
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影响因子：
6.7
作者：
Niemi, M.
通讯作者：
Niemi, M.
DOI：
10.1164/rccm.201209-1718oc
发表时间：
2013-04-01
影响因子：
24.7
作者：
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作者：
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影响因子：
38.9
作者：
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Gajic, Ognjen