Impact of prior statin therapy on the outcome of patients with suspected ventilator-associated pneumonia: an observational study.
Impact of prior statin therapy on the outcome of patients with suspected ventilator-associated pneumonia: an observational study.
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DOI：
10.1186/cc13845
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发表时间：
2014-04-28
期刊：
影响因子：
--
通讯作者：
Charles PE
中科院分区：
文献类型：
--
作者：
Bruyere R;Vigneron C;Prin S;Pechinot A;Quenot JP;Aho S;Papazian L;Charles PE
呼吸机相关性肺炎(VAP)是重症监护病房(ICU)最常见的获得性感染。其结果至少在一定程度上与东道主的反应有关。他汀类药物具有抗炎作用，因此可能会改善结果。我们的目的是评估先前使用他汀类药物对VAP的影响。一项为期六年的队列研究是在一家教学医院的法国重症监护室进行的。所有疑似VAP患者均纳入研究。前瞻性收集基线特征、结果、他汀类药物暴露和可疑发作的描述。主要终点是30天的死亡率。将入院前服用他汀类药物的患者与未接受他汀类药物治疗的患者(未服用他汀类药物的患者)进行比较。在整个队列和先前使用他汀类药物的子组中进行了使用Cox模型的生存分析。在纳入的349例患者中，93例(26.6%)服用了他汀类药物。在基线时，这些患者比未服用他汀类药物的患者发生并发症的风险更高(例如，年龄较大、更有可能是男性、有基础疾病、简化的急性生理学评分II(SAPS II)更高)。然而，怀疑发生呼吸机相关性肺炎时的严重程度没有差异(序贯器官衰竭评估(SOFA)：9.0(4.0~16.0)比8.0(4.0~17.0)；P = 0.11)。然而，使用他汀类药物的患者与未使用他汀类药物的患者相比，30天的死亡率并无差异(分别为35.5%和26.2%；调整后的危险比(HR) = 为1.23(0.79到1.9)95%可信区间(CI)；P = 为0.36)。相反，在对先前使用他汀类药物的患者进行限制分析并调整潜在的混杂因素后，继续使用他汀类药物的患者的存活率高于不使用他汀类药物的患者(HR = 为0.47；(0.22至0.97)95%CI；P = 为0.04)。继续服用他汀类药物可以为疑似VAP患者提供保护作用。
Ventilator-associated pneumonia (VAP) is the most commonly acquired infection in intensive care units (ICU). Its outcome is related, at least in part, to the host’s response. Statins have anti-inflammatory effects and may thus improve the outcome. We aimed to assess the impact of prior statin use in the setting of VAP. A six-year cohort study was conducted in a French ICU at a teaching hospital. All of the patients with suspected VAP were included. Baseline characteristics, outcomes, statin exposure, and the description of suspected episodes were collected prospectively. The primary endpoint was 30-day mortality. Patients who were taking statins before admission to the ICU whether or not treatment was continued thereafter (‘previous users’ group) were compared to those without prior statin therapy (‘statin-naive’ group). A survival analysis using a Cox model was conducted in the whole cohort and in the subgroup of prior statin users. Among the 349 patients included, 93 (26.6%) had taken statins. At baseline, these patients were at higher risk of complications than statin-naive ones (for example, older, more likely to be men and to have underlying diseases, greater simplified acute physiology score II (SAPS II)). There was, however, no difference regarding severity at the time VAP was suspected (sequential organ failure assessment (SOFA): 9.0 (4.0 to 16.0) versus 8.0 (4.0 to 17.0); P = 0.11). Nonetheless, 30-day mortality in statin users was not different from that in statin-naive patients (35.5% versus 26.2%, respectively; adjusted hazard ratio (HR) = 1.23 (0.79 to 1.90) 95% confidence interval (CI); P = 0.36). In contrast, after limiting analysis to prior statin users and adjusting for potential confounders, those who continued the treatment had better survival than those who did not (HR = 0.47; (0.22 to 0.97) 95% CI; P = 0.04). Statin continuation in prior users could provide protective effects in patients with suspected VAP.
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DOI：
10.1164/rccm.200406-746oc
发表时间：
2005-01-01
影响因子：
24.7
作者：
Luyt, CE;Guérin, V;Chastre, J
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发表时间：
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DOI：
10.1164/rccm.200212-1449oc
发表时间：
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影响因子：
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