The effect of statins on mortality from severe infections and sepsis: a systematic review and meta-analysis.
The effect of statins on mortality from severe infections and sepsis: a systematic review and meta-analysis.
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DOI：
10.1016/j.jcrc.2010.02.013
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发表时间：
2010-12-01
影响因子：
3.7
通讯作者：
Swiston, John
中科院分区：
文献类型：
--
作者：
Janda, Surinder;Young, Aaron;Swiston, John
目得：本研究的目的是系统地回顾他汀类药物对感染和/或败血症患者死亡率的影响的文献。材料和方法：检索MEDLINE、EMBASE、PapersFirst、科克伦协作和科克伦对照试验登记册，并于2009年12月更新。纳入了随机、双盲或单盲、安慰剂对照研究;观察性队列研究（回顾性和前瞻性）;以及病例对照研究。参与者的类型包括患有败血症或各种其他类型感染的成人和儿童受试者。暴露定义为使用他汀类药物治疗任何适应症。选择的主要结局是任何原因的死亡率，次要结局包括30天死亡率、住院死亡率、肺炎死亡率、菌血症死亡率、脓毒症死亡率和混合感染死亡率。共有20项研究纳入分析，其中18项为队列研究（12项回顾性研究，6项前瞻性研究），1项匹配队列研究，2项病例对照研究和1项随机对照试验。各种感染相关结局的荟萃分析显示，以下合并优势比均支持使用他汀类药物vs不使用他汀类药物：0.61（95%置信区间[CI]，0.48-0.73）30天死亡率（n = 7），0.38（95% CI，0.13-0.64）住院死亡率（n = 7），0.63（95% CI，0.55-0.71）肺炎相关死亡率（n = 7），0.33（95% CI，0.09-0.75）菌血症相关死亡率（n = 4），0.40脓毒症相关死亡率（n = 4）（95% CI，0.23-0.57）和0.50（95%CI，0.18-0.83）混合感染相关死亡率（n = 4）.结论：这项荟萃分析表明，与安慰剂相比，他汀类药物对脓毒症和/或其他感染患者的各种感染相关结局具有保护作用。然而，我们的结果受到所选研究的队列设计和异质性程度的限制，因此，需要进一步的随机试验来验证他汀类药物治疗脓毒症和/或其他感染的有效性。
PURPOSE: The aim of this study was to systematically review the literature on the effect of statins on mortality in patients with infection and/or sepsis.MATERIALS AND METHODS: MEDLINE, EMBASE, PapersFirst, and the Cochrane collaboration and the Cochrane Register of controlled trials were searched and were current as of December 2009. Randomized, double-blind or single-blind, placebo-controlled studies; observational cohort studies (retrospective and prospective); and case-controlled studies were included. Types of participants included adult and pediatric subjects with sepsis or various other types of infection. Exposure was defined as the use of a statin for any indication. The primary outcome chosen was mortality from any cause, and secondary outcomes included 30-day mortality, in-hospital mortality, mortality from pneumonia, mortality from bacteremia, mortality from sepsis, and mortality from mixed infection.RESULTS: A total of 20 studies were included in the analysis, 18 being cohort studies (12 retrospective, 6 prospective), 1 matched cohort study with 2 case-control studies, and 1 randomized control trial. Meta-analysis for various infection-related outcomes revealed the following pooled odds ratios all in favor of statin use vs non: 0.61 (95% confidence interval [CI], 0.48-0.73) for 30-day mortality (n = 7), 0.38 (95% CI, 0.13-0.64) for in-hospital mortality (n = 7), 0.63 (95% CI, 0.55-0.71) for pneumonia-related mortality (n = 7), 0.33 (95% CI, 0.09-0.75) for bacteremia-related mortality (n = 4), 0.40 (95% CI, 0.23-0.57) for sepsis-related mortality (n = 4), and 0.50 (95% CI, 0.18-0.83) for mixed infection-related mortality (n = 4).CONCLUSIONS: This meta-analysis demonstrated a protective effect for statins in patients with sepsis and/or other infections compared to placebo for various infection-related outcomes. However, our results are limited by the cohort design of the selected studies and the degree of heterogeneity among them, and as a result, further randomized trials are needed to validate the use of statins for sepsis and/or other infections.