title: Prehospital statin and aspirin use and the prevalence of severe sepsis and acute lung injury/acute respiratory distress syndrome.
abstract: OBJECTIVE
  To determine whether prehospital statin use is associated with a lower risk of sepsis, acute lung injury/acute respiratory distress syndrome, and mortality in critically ill patients. We also investigated the effect of combined prehospital use of both statins and aspirin.
  
  
  METHODS
  Cross-sectional analysis of a prospective cohort.
  
  
  METHODS
  A total of 575 critically ill patients admitted to the medical or surgical intensive care unit of an academic tertiary-care hospital.
  
  
  METHODS
  None.
  
  
  RESULTS
  Of 575 patients, 149 (26%) were on statin therapy before hospitalization. A multivariable analysis including age, gender, current tobacco use, prehospital aspirin use, race, and Acute Physiology and Chronic Health Evaluation II score revealed that patients on statin therapy before hospitalization were less likely to have or develop severe sepsis (odds ratio 0.62, 95% confidence interval 0.40-0.96) or acute lung injury/acute respiratory distress syndrome (odds ratio 0.60, 95% confidence interval 0.36-0.99) during the first four intensive care unit days. In-hospital mortalities for patients with and without prehospital statin use (odds ratio 1.06, 95% confidence interval 0.62-1.83) were similar. Patients who had prehospital use of both statins and aspirin had the lowest rates of severe sepsis, acute lung injury/acute respiratory distress syndrome, and mortality.
  
  
  CONCLUSIONS
  Prehospital use of statins may be protective against sepsis and acute lung injury. This effect may be potentiated by prehospital aspirin use.
authors.affiliation: Department of Medicine, Section of Pulmonary & Critical Care Medicine, Louisiana State University Health Sciences Center, Baton Rouge, LA, USA. honeal@lsuhsc.edu
authors.forename: Hollis R
authors.initials: HR
authors.lastname: O'Neal
authors.forename: Tatsuki
authors.initials: T
authors.lastname: Koyama
authors.forename: Elizabeth A S
authors.initials: EA
authors.lastname: Koehler
authors.forename: Edward
authors.initials: E
authors.lastname: Siew
authors.forename: Blake R
authors.initials: BR
authors.lastname: Curtis
authors.forename: Richard D
authors.initials: RD
authors.lastname: Fremont
authors.forename: Addison K
authors.initials: AK
authors.lastname: May
authors.forename: Gordon R
authors.initials: GR
authors.lastname: Bernard
authors.forename: Lorraine B
authors.initials: LB
authors.lastname: Ware
mesh_terms: D055371:Acute Lung Injury / Q000453:epidemiology*; D000368:Aged; D001241:Aspirin / Q000627:therapeutic use*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D015995:Prevalence; D012128:Respiratory Distress Syndrome / Q000453:epidemiology*; D018805:Sepsis / Q000453:epidemiology*
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin