Preadmission statin use improves the outcome of less severe sepsis patients - a population-based propensity score matched cohort study
Preadmission statin use improves the outcome of less severe sepsis patients - a population-based propensity score matched cohort study
复制标题
DOI：
10.1093/bja/aex294
复制
发表时间：
2017-10-01
影响因子：
9.8
通讯作者：
Chen, Y. -M.
中科院分区：
文献类型：
--
作者：
Lee, M. G.;Lee, C. -C.;Chen, Y. -M.
背景资料。关于脓毒症患者入院后使用他汀类药物的随机对照试验没有显示出生存益处。入院前使用他汀类药物是否会对脓毒症患者产生任何有益的影响还没有很好的研究。我们在1999至2011年间对全国健康保险索赔数据库进行了一项以人群为基础的队列研究。脓毒症患者是通过ICD-9编码识别的，该编码与第三个国际公认的脓毒症定义兼容。他汀类药物的使用被定义为在指标性脓毒症入院前30天以上累计使用任何他汀类药物。我们通过多变量调整的COX比例风险模型和倾向分数匹配分析来确定他汀类药物的使用和脓毒症预后之间的关联。为了最小化他汀类药物使用者和非他汀类药物使用者之间的基线失衡，我们匹配/调整了社会经济状况、合并症、健康生活方式的替代品、卫生保健设施利用率和药物使用。我们确定了52737名脓毒症患者，其中3599人接受了他汀类药物治疗。他汀类药物的使用与多变量调整(HR 0.86，95%CI，0.78-0.94)和倾向评分匹配(HR，0.88；95%CI，0.78-0.99)后30天死亡率的降低有关。在亚组分析中，他汀类药物对接受呼吸机支持或需要ICU入院的患者的益处并不显著。在这项全国性的队列研究中，与从未服用他汀类药物的患者相比，在脓毒症发生前接受他汀类药物治疗的患者死亡率降低了12%。他汀类药物在所有患者亚组中没有一致的益处。
Background. Randomized controlled trials on the post-admission use of statins in sepsis patients have not shown a survival benefit. Whether preadmission use of statins would confer any beneficial effects in sepsis patients has not been well studied.Methods. We conducted a population-based cohort study on a national health insurance claims database between 1999 and 2011. Sepsis patients were identified by ICD-9 codes compatible with the third International consensus definitions for sepsis. Use of statin was defined as the cumulative use of any statin for more than 30 days before the indexed sepsis admission. We determined the association between statin use and sepsis outcome by multivariate-adjusted Cox proportional hazard models and propensity score matched analysis. To minimize baseline imbalance between statin users and non-statin users, we matched/adjusted for social economic status, comorbidities, proxies for healthy lifestyle, health care facility utilization, and use of medications.Results. We identified 52 737 sepsis patients, of which 3599 received statin treatment. Statins use was associated with a reduced 30-day mortality after multivariable adjustment (HR 0.86, 95% CI, 0.78-0.94) and propensity score matching (HR, 0.88; 95% CI, 0.78-0.99). On subgroup analysis, the beneficial effects of statins were not significant in patients receiving ventilator support or requiring ICU admission.Conclusions. In this national cohort study, preadmission statin therapy before sepsis development was associated with a 12% reduction in mortality when compared with patients who never received a statin. There were no consistent beneficial effects of statins in all patient subgroups.