Reduction in mortality associated with statin therapy in patients with severe sepsis.
OBJECTIVE
To evaluate the effect of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) on mortality in patients with severe sepsis.


METHODS
Retrospective cohort study.


METHODS
Intensive care unit (ICU) of an academic medical center.


METHODS
One hundred eighty-eight patients aged 40 years or older with a diagnosis of severe sepsis and an ICU stay between January 1, 2005, and December 31, 2006.


RESULTS
Patient demographic data, statin use, and Acute Physiology and Chronic Health Evaluation (APACHE) II scores at the time of sepsis diagnosis were collected from the patient database. We used a multivariable logistic regression model to evaluate the association between statin use and in-hospital all-cause mortality after controlling for age, sex, and severity of illness. Of the 188 patients who met our inclusion criteria, 60 (32%) had statin exposure. Patients receiving statins were similar in age, sex, and APACHE II scores to those not receiving statins. In the univariable comparison, the statin group had a 35% relative reduction in mortality compared with the nonstatin group (mortality rate 31.7% vs 48.4%, p=0.040). Most of the mortality reduction attributed to statins occurred in patients with APACHE II scores higher than 24 (mortality rate 32.3% vs 57.5%, p=0.031), with a minimal mortality difference in patients with APACHE II scores of 24 or lower (31% vs 36.4%, p=0.810). In the multivariable regression model, statin use had a protective effect (odds ratio [OR] 0.42, 95% confidence interval [CI] 0.21-0.84, p=0.014), whereas increasing age (OR 1.03, 95% CI 1.01-1.06, p=0.013) and higher APACHE II score (OR 1.11, 95% CI 1.05-1.18, p=0.001) were associated with increased mortality.


CONCLUSIONS
The use of statins was associated with a protective effect in patients with severe sepsis, as demonstrated by a significant reduction in mortality compared with patients not receiving statins.
Dobesh
Paul P
PP
College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska 68198-6045, USA. pdobesh@unmc.edu
Klepser
Donald G
DG
McGuire
Timothy R
TR
Morgan
Craig W
CW
Olsen
Keith M
KM
D018806:APACHE; D000046:Academic Medical Centers; D000328:Adult; D016022:Case-Control Studies; D003422:Critical Care; D016208:Databases, Factual; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007249:Inflammation; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D009329:Nebraska; D018805:Sepsis / Q000188:drug therapy* / Q000401:mortality*; D012720:Severity of Illness Index
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors