Effectiveness of statins in reducing the rate of severe sepsis: A retrospective evaluation
Effectiveness of statins in reducing the rate of severe sepsis: A retrospective evaluation
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DOI：
10.1592/phco.27.1.20
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发表时间：
2007-01-01
期刊：
影响因子：
4.1
通讯作者：
Peters, Jay I.
中科院分区：
文献类型：
--
作者：
Martin, Christopher P.;Talbert, Robert L.;Peters, Jay I.
研究目的。确定使用3-羟基-3-甲基戊二酰辅酶A还原酶抑制剂（他汀类药物）是否与严重脓毒症发生率降低相关，并进一步描述他汀类药物对严重脓毒症患者器官功能障碍发生率的影响。回顾性队列研究。大学附属教学医院。53例脓毒症患者入院，16例接受他汀类药物治疗，37例入院前未接受他汀类药物治疗（对照组）。根据国际疾病分类第九次修订版临床修改代码确定患者。从电子病历中收集患者人口统计学、生命体征和实验室检查值。主要终点是严重脓毒症的发生率，根据美国胸科医师学会和重症监护医学会的指南进行定义。次要终点为住院死亡率。五类器官功能障碍（心血管、肾、肺、血液和代谢）的发生率和发生率。与未接受他汀类药物治疗相比，入院前接受他汀类药物治疗的患者严重脓毒症发生率降低30%（56% vs 86%，p < 0.02）。两组的住院死亡率无显著差异（38% vs 49%，p=0.33）;然而，心血管功能障碍（定义为需要血管加压治疗的低血压）的发生率在他汀类药物组显著较低（38% vs 73%，p < 0.02）。其他器官功能障碍的分类在两组间无显著差异。他汀类药物似乎可以防止脓毒症变得严重，最明显的是通过预防脓毒症引起的低血压。他汀类药物在预防和治疗严重脓毒症中的潜在作用应在随机对照试验中进一步评估。
Study Objectives. To determine whether use of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) is associated with a reduced rate of severe sepsis, and to further characterize the effect of statins on the frequency of organ dysfunction in patients with severe sepsis.Design. Retrospective cohort study.Setting. University-associated teaching hospital.Patients. Fifty-three patients admitted with sepsis; 16 were receiving statins and 37 were not receiving statins (controls) before admission.Measurements and Main Results. Patients were identified by the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Patient demographics, vital signs, and laboratory values were collected from their electronic medical records. The primary end point was rate of severe sepsis, defined in accordance with guidelines from the American College of Chest Physicians and the Society of Critical Care Medicine. Secondary end points were in-hospital mortality. rate and rate of five categories of organ dysfunction (cardiovascular, renal, pulmonary, hematologic, and metabolic). Preadmission statin therapy, compared with no statin therapy, was associated with a 30% lower rate of severe sepsis (56% vs 86%, p < 0.02). In-hospital mortality was not significantly different between groups (38% vs 49%, p=0.33); however, the rate of cardiovascular dysfunction, defined as hypotension requiring vasopressor therapy, was significantly lower in the statin group (38% vs 73%, p < 0.02). No significant differences in the other organ dysfunction categories were noted between groups.Conclusion. Statins appear to prevent sepsis from becoming severe, most notably through prevention of sepsis-induced hypotension. This potential role for statins in the prevention and treatment of severe sepsis should be further evaluated in a randomized controlled trial.