Statin administration did not influence the progression of lung injury or associated organ failures in a cohort of patients with acute lung injury
Statin administration did not influence the progression of lung injury or associated organ failures in a cohort of patients with acute lung injury
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DOI：
10.1007/s00134-009-1421-8
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发表时间：
2009-06-01
影响因子：
38.9
通讯作者：
Gajic, Ognjen
中科院分区：
文献类型：
--
作者：
Kor, Daryl J.;Iscimen, Remzi;Gajic, Ognjen
临床前研究表明，HMG-CoA还原酶抑制剂（他汀类药物）可能会减轻器官功能障碍。我们评估了他汀类药物是否与减轻ALI/ARDS患者的肺损伤和预防相关器官衰竭有关。我们从ALI/ARDS患者数据库中确定了他汀类药物的存在和给药时间。主要结果指标是肺和非肺器官衰竭的发展和进展，通过在ALI/ARDS发作后第1天至第7天之间PaO 2/FiO（2）比值和序贯器官衰竭评估评分（SOFA）的变化进行评估。次要结果包括无呼吸机天数、ICU和住院死亡率、ICU和住院时间。在178例ALI/ARDS患者中，45例（25%）接受他汀类药物治疗。从第1天到第7天，他汀类药物组的PaO 2/FiO（2）比值改善较少（27 vs. 55，P = 0.042）。他汀类药物组和非他汀类药物组的无呼吸机天数（中位数21 vs. 16天，P = 0.158）、器官衰竭发生或进展（中位数Δ SOFA 1 vs. 2，P = 0.275）、ICU死亡率（20% vs. 23%，P = 0.643）和住院死亡率（27 vs. 37%，P = 0.207）无显著差异。在调整基线特征和他汀类药物使用倾向后，ICU或住院时间无差异。在这项回顾性队列研究中，他汀类药物的使用与ALI/ARDS患者预后的改善无关。我们无法找到保护肺或非肺器官功能障碍的证据。
Preclinical studies suggest that HMG-CoA reductase inhibitors (statins) may attenuate organ dysfunction. We evaluated whether statins are associated with attenuation of lung injury and prevention of associated organ failure in patients with ALI/ARDS.From a database of patients with ALI/ARDS, we determined the presence and timing of statin administration. Main outcome measures were the development and progression of pulmonary and nonpulmonary organ failures as assessed by changes in PaO2/FiO(2) ratio and Sequential Organ Failure Assessment score (SOFA) between days 1 and 7 after the onset of ALI/ARDS. Secondary outcomes included ventilator free days, ICU and hospital mortality, and lengths of ICU and hospital stay.From 178 patients with ALI/ARDS, 45 (25%) received statin therapy. From day 1 to day 7, the statin group showed less improvement in their PaO2/FiO(2) ratio (27 vs. 55, P = 0.042). Ventilator free days (median 21 vs. 16 days, P = 0.158), development or progression of organ failures (median Delta SOFA 1 vs. 2, P = 0.275), ICU mortality (20% vs. 23%, P = 0.643), and hospital mortality (27 vs. 37%, P = 0.207) were not significantly different in the statin and non-statin groups. After adjustment for baseline characteristics and propensity for statin administration, there were no differences in ICU or hospital lengths of stay.In this retrospective cohort study, statin use was not associated with improved outcome in patients with ALI/ARDS. We were unable to find evidence for protection against pulmonary or nonpulmonary organ dysfunction.