Statins and outcomes in patients with bloodstream infection: a propensity-matched analysis.
OBJECTIVE
The pleiotropic effects of statins, 3-hydroxy-3 methylglutaryl coenzyme A reductase inhibitor, have been shown to modify inflammatory cell signaling on the immune response to infection. It was postulated that statins may be a good candidate as novel therapeutic agents for the treatment of sepsis. We investigated whether ongoing statin therapy is associated with mortality in patients with bloodstream infection.


METHODS
A retrospective cohort study.


METHODS
Two tertiary hospitals in Bronx, NY.


METHODS
Adult patients in the hospital with bloodstream infection and categorized according to statin therapy as an outpatient or inpatient before bacteremia.


METHODS
None.


RESULTS
Of 2,139 bacteremic hospitalized patients, 592 (28%) received statins before blood cultures and 677 (32%) died within 90 days. On multivariate adjustment, the association between statin therapy and 90-day all-cause mortality was statistically significant (hazard ratio, 0.78; 95% confidence interval [CI] 0.65-0.94), but statin users and nonusers differed significantly on many baseline clinical factors. Using the propensity score matched analysis to balance the differences between groups, the association was no longer significant (hazard ratio 0.99; 95% CI 0.77-1.25). Multivariate analysis after stratifying by decile in propensity score for statin use demonstrated similar results (hazard ratio 0.86; 95% CI 0.70-1.06). Statin use was not associated with reduced intensive care unit admission (odds ratio [OR], 0.86; 95% CI 0.59-1.26), hospital length of stay (β = -0.8 days; 95% CI -2.2 to 1.7 days), intensive care unit length of stay (β = -0.1 days; 95% CI -3.7 to 3.8 days), or need for mechanical or noninvasive ventilation (OR 1.03; 95% CI 0.70-1.51).


CONCLUSIONS
After adjusting for the propensity to receive statin therapy, no statistically significant association between statin therapy before bloodstream infection and survival was identified.
Division of Critical Care Medicine, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA. sleung@montefiore.org
Sharon
S
Leung
Reha
R
Pokharel
Michelle N
MN
Gong
D000368:Aged; D016470:Bacteremia / Q000188:drug therapy* / Q000401:mortality; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D016016:Proportional Hazards Models; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors