Reduction in Mortality Associated with Statin Therapy in Patients with Severe Sepsis
Reduction in Mortality Associated with Statin Therapy in Patients with Severe Sepsis
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DOI：
10.1592/phco.29.6.621
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发表时间：
2009-06-01
期刊：
影响因子：
4.1
通讯作者：
Olsen, Keith M.
中科院分区：
文献类型：
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作者：
Dobesh, Pan P.;Klepser, Donald G.;Olsen, Keith M.
研究目的。目的评价3-羟基-3-甲基戊二酰辅酶A还原酶抑制剂（他汀类药物）对重症脓毒症患者死亡率的影响。回顾性队列研究。一所学术医疗中心的重症监护室（ICU）。从2005年1月至2006年12月31日，188例年龄在40岁或以上，诊断为严重脓毒症并入住ICU的患者。从患者数据库中收集脓毒症诊断时的患者人口统计学数据、他汀类药物使用情况和急性生理学和慢性健康评价（APACHE）II评分。在控制年龄、性别和疾病严重程度后，我们使用多变量logistic回归模型评估他汀类药物使用与住院全因死亡率之间的相关性。在188例符合我们纳入标准的患者中，60例（32%）有他汀类药物暴露。接受他汀类药物治疗的患者在年龄、性别和APACHE II评分方面与未接受他汀类药物治疗的患者相似。在单变量比较中，与非他汀类药物组相比，他汀类药物组的死亡率相对降低35%（死亡率31.7% vs 48.4%，p=0.040）。他汀类药物导致的死亡率降低主要发生在APACHE II评分高于24分的患者中（死亡率为32.3% vs 57.5%，p=0.030），APACHE II评分为24分或更低的患者死亡率差异极小（31% vs 36.4%，p=0.810）。在多变量回归模型中，他汀类药物的使用具有保护作用（比值比[OR] 0.42，95%置信区间[CI] 0.21-0-84，p=0.014），而随着年龄的增加，（OR 1.03，95%CI 1.01-1.06，p=0.013）和较高的APACHE II评分（OR 1.11，95%CI 1.05-1.18，p=0.00.1）与死亡率增加相关。他汀类药物的使用与严重脓毒症患者的保护作用有关，这一点已被一项显著的研究所证实。与未接受他汀类药物的患者相比，死亡率降低。
Study Objective. To evaluate the effect of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) on mortality ill patients Mill severe sepsis.Design. Retrospective cohort study.Setting. Intensive Care Unit (ICU) of an academic medical center.Patients. One hundred eighty-eight patients aged 40 years or older with a diagnosis of severe sepsis and an ICU stay between January 2005, mid December 31, 2006.Measurements and Main Results. Patient demographic data, statin use, and Acute Physiology and Chronic Health Evaluation (APACHE) II scores at the time of sepsis diagnosis were collected from the patient database. We used a multivariable logistic regression model to evaluate the association between statin use and in-hospital all-cause mortality after controlling for age, sex, and severity of illness. Of the 188 patients who met our inclusion criteria, 60 (32%) had statin exposure. Patients receiving statins were similar in age, sex, and APACHE II scores to those not receiving statins. In the univariable comparison, the statin group had a 35%, relative reduction in mortality compared with the nonstatin group (mortality rate 31.7% vs 48.4%, p=0.040). Most of the mortality reduction attributed to statins occurred hi patients with APACHE II scores higher than 24 (mortality rate 32.3% vs 57.5%, p=0.030, with a minimal mortality difference in patients with APACHE II scores of 24 or lower (31% vs 36.4%, p=0.810). In the multivariable regression model, statin use had a protective effect (odds ratio [OR] 0.42, 95% confidence interval [CI] 0.21-0-84, p=0.014), whereas increasing age (OR 1.03, 95% CI 1.01-1.06, p=0.013) and higher APACHE II score (OR.1.11, 95% CI 1.05-1.18, p=0.00.1) were associated with increased mortality.Conclusion. The use of statins was associated with a protective effect ill patients with severe sepsis, as demonstrated by a significant. reduction ill mortality compared with patients not receiving statins.