title: The association of prior statin use in septic shock treated with early goal directed therapy.
abstract: BACKGROUND
  Previous literature suggests statins may have a therapeutic role in sepsis. No data have examined if statin use may have a positive impact beyond that afforded by early goal directed therapy (EGDT).
  
  
  OBJECTIVE
  To test the hypothesis that previous statin use is associated with improved clinically relevant outcomes in patients with severe sepsis and septic shock receiving EGDT.
  
  
  METHODS
  Retrospective cohort study of 91 patients who presented in an academic center in severe sepsis or septic shock and received EGDT. Primary outcome was mortality and secondary outcomes included mechanical ventilation days, ICU length of stay, and hospital length of stay.
  
  
  RESULTS
  Patients (87 of 91) presented to the Emergency Department before ICU admission. Patients (18 of 91) were receiving statin therapy before presentation. The statin group had a mortality rate of 22.2 vs. 39.7% in the nonstatin group (P=0.273). The statin group had fewer mechanical ventilation days (8.49 vs. 7.29 days, P=0.026), and a trend in improved hospital length of stay (17.9 vs. 14.4 days, P=0.065), and ICU length of stay (7.15 vs. 4.89 days, P=0.077).
  
  
  CONCLUSIONS
  Prior statin use is associated with fewer mechanical ventilation days and a trend toward improvement in other clinically relevant outcomes. This trial is limited by its retrospective nature and small sample size. These results should serve as hypothesis generating for future prospective trials, as the lack of novel drug therapy and the mortality rate of septic shock both remain unacceptable.
authors.affiliation: Department of Anesthesiology, Division of Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA. fullerb@wusm.wustl.edu
authors.forename: Brian M
authors.initials: BM
authors.lastname: Fuller
authors.forename: Mithil
authors.initials: M
authors.lastname: Gajera
authors.forename: Christa
authors.initials: C
authors.lastname: Schorr
authors.forename: David
authors.initials: D
authors.lastname: Gerber
authors.forename: R Phillip
authors.initials: RP
authors.lastname: Dellinger
authors.forename: Sergio
authors.initials: S
authors.lastname: Zanotti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009026:Mortality; D012189:Retrospective Studies; D012772:Shock, Septic / Q000139:chemically induced* / Q000188:drug therapy / Q000209:etiology; D013223:Statistics as Topic; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors