title: Statin therapy as prevention against development of acute respiratory distress syndrome: an observational study.
abstract: OBJECTIVE
  The 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors ("statins") have anti-inflammatory properties and are associated with improved outcomes in critically ill patients. We investigated whether previous statin therapy affects outcomes in patients at risk for acute respiratory distress syndrome.
  
  
  METHODS
  Patients were followed-up for the primary outcome of acute respiratory distress syndrome and secondary outcomes of intensive care unit and 60-day mortality, organ dysfunction, and ventilator-free days in a secondary analysis of a prospective cohort study. Receipt of statin therapy was recorded. Propensity score matching was used to adjust for confounding by indication.
  
  
  METHODS
  Intensive care units at a tertiary care academic medical center.
  
  
  METHODS
  Critically ill patients (2,743) with acute respiratory distress syndrome risk factors.
  
  
  METHODS
  None.
  
  
  RESULTS
  Acute respiratory distress syndrome developed in 738 (26%) patients; 413 patients (15%) received a statin within 24 hrs of intensive care unit admission. Those who had received a statin within 24 hrs had a lower rate of development of acute respiratory distress syndrome (odds ratio 0.56; 95% confidence interval 0.43-0.73; p<.0001). After multivariate adjustment for potential confounders, this association remained significant (odds ratio 0.69; 95% confidence interval 0.51-0.92; p=.01). However, after propensity score matching, the association was not statistically significant (odds ratio 0.79; 95% confidence interval 0.57-1.10; p=.16). Statin use was not associated with reduced acute respiratory distress syndrome mortality, organ dysfunction, or ventilator-free days. Results of the study were presented in accordance with STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines.
  
  
  CONCLUSIONS
  Statin therapy at the time of intensive care unit admission was not associated with a lower rate of development of acute respiratory distress syndrome after matching for patient propensity to receive statins. Statin therapy was not associated with improvements in acute respiratory distress syndrome mortality, organ failure, or days free from mechanical ventilation.
authors.affiliation: Pulmonary & Critical Care Unit, Department of Medicine, Massachusetts General Hospital, and Department of Environmental and Occupational Health, Harvard School of Public Health, Boston, MA, USA. ebajwa@partners.org
authors.forename: Ednan K
authors.initials: EK
authors.lastname: Bajwa
authors.forename: Cindy K
authors.initials: CK
authors.lastname: Malhotra
authors.forename: B Taylor
authors.initials: BT
authors.lastname: Thompson
authors.forename: David C
authors.initials: DC
authors.lastname: Christiani
authors.forename: Michelle N
authors.initials: MN
authors.lastname: Gong
mesh_terms: D018806:APACHE; D000368:Aged; D016638:Critical Illness / Q000401:mortality; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007362:Intensive Care Units / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D057216:Propensity Score; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000517:prevention & control*; D012307:Risk Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors