title: Statin use and risk of delirium in the critically ill.
abstract: BACKGROUND
  Delirium is common in intensive care unit (ICU) patients and is a predictor of worse outcomes and neuroinflammation is a possible mechanism. The antiinflammatory actions of statins may reduce delirium.
  
  
  OBJECTIVE
  To determine whether critically ill patients receiving statin therapy had a reduced risk of delirium than those not on statins.
  
  
  METHODS
  A prospective cohort analysis of data from consecutive ICU patients admitted to a UK mixed medical and surgical critical care unit between August 2011 and February 2012; the Confusion Assessment Method for ICU was used to determine the days each patient was assessed as being free of delirium during ICU admission.
  
  
  RESULTS
  Delirium-free days, daily administration of statins, and serum C-reactive protein (CRP) were recorded. Four hundred and seventy consecutive critical care patients were followed, of whom 151 patients received statins. Using random-effects multivariable logistic regression, statin administration the previous evening was associated with the patient being assessed as free of delirium (odds ratio, 2.28; confidence interval, 1.01-5.13; P < 0.05) and with lower CRP (β = -0.52; P < 0.01) the following day. When the association between statin and being assessed as free of delirium was controlled for CRP, the effect size became nonsignificant (odds ratio, 1.56; confidence interval, 0.64-3.79; P = 0.32).
  
  
  CONCLUSIONS
  Ongoing statin therapy is associated with a lower daily risk of delirium in critically ill patients. An ongoing clinical trial, informed by this study, is investigating if statins are a potential therapy for delirium in the critically ill.
authors.affiliation: 1 Intensive Care Unit, Watford General Hospital, West Hertfordshire Hospitals NHS Trust, Watford, United Kingdom.
authors.forename: Valerie J
authors.initials: VJ
authors.lastname: Page
authors.forename: Daniel
authors.initials: D
authors.lastname: Davis
authors.forename: Xiao B
authors.initials: XB
authors.lastname: Zhao
authors.forename: Samuel
authors.initials: S
authors.lastname: Norton
authors.forename: Annalisa
authors.initials: A
authors.lastname: Casarin
authors.forename: Thomas
authors.initials: T
authors.lastname: Brown
authors.forename: E Wesley
authors.initials: EW
authors.lastname: Ely
authors.forename: Daniel F
authors.initials: DF
authors.lastname: McAuley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D003422:Critical Care / Q000379:methods*; D003693:Delirium / Q000097:blood / Q000175:diagnosis / Q000517:prevention & control*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007362:Intensive Care Units; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D057216:Propensity Score; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002097:C-Reactive Protein