title: Statin therapy prior to ICU admission: protection against infection or a severity marker?
abstract: OBJECTIVE
  Examine the impact of previous statin therapy on hospital mortality and whether it is due to a protective effect against ICU-acquired infections.
  
  
  METHODS
  Cohort comparison study by retrospective chart-based analysis in a 26-bed, university-affiliated, medical-surgical ICU.
  
  
  METHODS
  We analyzed data from 438 patients at high risk of ICU-acquired infections, i.e., those receiving mechanical ventilation for more than 96 h, 38 (8.7%) of whom had been treated with statins prior to and during ICU admission.
  
  
  RESULTS
  We recorded clinical characteristics, number and type of ICU-acquired infections, and ICU and hospital mortality. Statin-treated patients were older (71.7+/-8.3 vs. 61.5+/-18.3 years), but differences in predicted mortality risk by APACHE II (39.5+/-24.7 vs. 35.8+/-24.3%) did not reach statistical significance. The ICU-acquired infection rate in statin-treated patients was nonsignificantly lower (29% vs. 38%) and delayed (median 12 vs.10 days), without differences regarding the source of infections. Nevertheless, hospital mortality was significantly higher in statin-treated patients (61% vs. 42%), even after adjustment for APACHE II predicted risk (observed/expected ratio 1.53 vs. 1.17).
  
  
  CONCLUSIONS
  Statin therapy is associated with worse outcome, probably because underlying clinical conditions are insufficiently considered in mortality predictors. Its presumed protective effect against ICU infections remains unconfirmed.
authors.affiliation: Critical Care Center, Hospital de Sabadell, Institut Universitari Parc Tauli, Universitat Autonoma de Barcelona, Parc Taulí s/n, 08208 Sabadell, Spain. rfernandez@cspt.es
authors.forename: Rafael
authors.initials: R
authors.lastname: Fernandez
authors.forename: Victor Jose
authors.initials: VJ
authors.lastname: De Pedro
authors.forename: Antonio
authors.initials: A
authors.lastname: Artigas
mesh_terms: D018806:APACHE; D000368:Aged; D015331:Cohort Studies; D003428:Cross Infection / Q000517:prevention & control*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D018570:Risk Assessment
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors