Statin research in critical illness: hampered by poor trial design?
Statin therapy may prevent an excessive inflammatory response after cardiopulmonary bypass for cardiac surgery. In a recent issue of Critical Care, Morgan and colleagues present data from a well-conducted systematic review and meta-analysis of randomised controlled trials using inflammatory markers as primary outcome measure. They find that pre-operative statin therapy, compared with placebo, may reduce various post-operative markers of systemic inflammation (IL-6, IL-8, C-reactive protein, tumour necrosis factor-alpha). Their ability to make definitive conclusions is limited, however, by the suboptimal methodological quality of the primary studies. Their review suggests that ICU researchers should focus on developing valid surrogate markers and use these to accurately describe the mechanisms and effectiveness of novel therapies before proceeding to large pragmatic trials using mortality as primary outcome.
Terblanche
Marius
M
Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK. marius.terblanche@gstt.nhs.uk
Adhikari
Neill K J
NK
D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D002986:Clinical Trials as Topic; D016638:Critical Illness; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007249:Inflammation / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control; D015203:Reproducibility of Results; D018570:Risk Assessment
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors