Continuation of Statin Therapy and Vasopressor Use in Septic Shock
Continuation of Statin Therapy and Vasopressor Use in Septic Shock
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DOI：
10.1177/1060028015579987
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发表时间：
2015-04
影响因子：
2.9
通讯作者：
C. Zechmeister;J. Hurren;Kelly McNorton
中科院分区：
文献类型：
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作者：
C. Zechmeister;J. Hurren;Kelly McNorton
背景：研究评估了他汀类药物在败血症中的应用；然而，没有人类研究探索它们对感染性休克中血管加压素需求的影响。目的：主要目的是确定院前他汀类药物持续治疗对感染性休克患者血管加压治疗持续时间的影响。次要目标包括最大和平均血管加压剂剂量和住院死亡率。方法：这是一项回顾性的、机构委员会批准的、在社区教学医院进行的观察性队列研究；对119例患有ICD-9编码的脓毒性休克和院前他汀类药物治疗的成人重症监护病房（ICU）患者进行了评估。进行多变量分析以解决混杂因素。结果：1229例患者中，119例（10%）符合纳入标准；73例患者（61%）在ICU入院24小时内继续服用他汀类药物。粗略分析显示，他汀类药物组与未使用他汀类药物组的血管加压持续时间无差异（3.3天vs 4.8天；P = 0.21）。最大（17.9±16.1 vs 23.8±21.7µg/min去甲肾上腺素当量[NEQ]； P = 0.1）或平均血管加压剂剂量（9.5±8.4 vs 12.1±11.5µg/min NEQ; P = 0.17）均无差异。他汀类药物患者的死亡率降低（43% vs 67%; P = 0.05）。在对潜在混杂因素进行调整后，任何结果都没有差异，他汀类药物组的死亡率持续下降。结论：院前继续他汀类药物治疗既没有减少脓毒性休克患者的持续时间，也没有减少血管加压药物的剂量，但有降低死亡率的趋势。
Background: Studies have evaluated the use of statins in sepsis; however, no human studies have explored their effect on vasopressor requirements in septic shock. Objective: The primary objective was to determine the effect of prehospital statin continuation on duration of vasopressor therapy in patients with septic shock. Secondary objectives included maximum and average vasopressor dose and in-hospital mortality. Methods: This was a retrospective, institutional board–approved, observational cohort study in a community teaching hospital; 119 adult intensive care unit (ICU) patients with an ICD-9 code for septic shock and prehospital statin therapy were evaluated. Multivariate analyses were performed to address confounders. Results: Of the 1229 patients screened, 119 (10%) met inclusion criteria; 73 patients (61%) had a statin continued within 24 hours of ICU admission. Crude analysis demonstrated no difference in vasopressor duration in the statin versus no statin group (3.3 vs 4.8 days; P = 0.21). There was no difference in either maximum (17.9 ± 16.1 vs 23.8 ± 21.7 µg/min norepinephrine equivalents [NEQs]; P = 0.1) or average vasopressor dose (9.5 ± 8.4 vs 12.1 ± 11.5 µg/min NEQ; P = 0.17). There was a decrease in mortality in the statin patients (43% vs 67 %; P = 0.05). On adjustment for potential confounders, there was no difference in any outcome, with a persistent trend toward lower mortality in the statin group. Conclusion: Continuation of prehospital statin therapy decreased neither duration nor dose of vasopressors in patients with septic shock but yielded a trend toward decreased mortality.