title: Statin therapy is associated with reduced incidence of hypoxic hepatitis in critically ill patients.
abstract: OBJECTIVE
  Hypoxic hepatitis (HH) is a frequent and life-threatening complication associated with states of oxygen depletion in critically ill patients. Ischemia and reperfusion contribute to liver injury in HH. Experimental data suggest beneficial effects of statins in hepatic ischemia/reperfusion injury. This study was conducted to investigate whether statin treatment prior to intensive care unit (ICU) admission affects incidence rates and severity of HH.
  
  
  METHODS
  Eight hundred fifty-one patients admitted consecutively to three medical ICUs between December 2008 and December 2009 were prospectively screened for new occurrence of HH within 48 h following ICU admission. Statin treatment prior to ICU admission was assessed. 28-day-, 90-day-, and 1-year-survival as well as new-onset of complications in HH patients were prospectively documented.
  
  
  RESULTS
  Eighty-seven patients (10%) developed HH. Statin treatment prior to ICU admission was significantly associated with decreased incidence of HH within 48 h after ICU admission in the multivariate analysis (adjusted OR=0.42 (95% CI 0.19-0.95); p<0.05). Cardiogenic shock (p<0.001), septic shock (p<0.001) and active alcohol consumption (p<0.01) were identified as independent risk factors for development of HH. 28-day-, 90-day-, and 1-year-mortality rates in HH were 58%, 67%, and 74%, respectively. Statins were associated with improved 28-day-survival in the total study cohort (p<0.05), but did not affect 90-day- and 1-year-mortality, respectively.
  
  
  CONCLUSIONS
  Cardiogenic shock, septic shock, and active alcohol consumption were independent factors predisposing patients to new onset of HH. Statin treatment prior to ICU admission was the only protective factor regarding the new occurrence of HH in critically ill patients.
authors: Intensive Care Unit 13 H1, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Austria.
authors: Andreas
authors: A
authors: Drolz
authors: Intensive Care Unit 13 H1, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Austria.
authors: Thomas
authors: T
authors: Horvatits
authors: Intensive Care Unit 13 H1, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Austria.
authors: Barbara
authors: B
authors: Michl
authors: Intensive Care Unit 13 H1, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Austria.
authors: Kevin
authors: K
authors: Roedl
authors: Intensive Care Unit 13 I2, Department of Oncology and Infectious Diseases, Division of Internal Medicine I, Medical University of Vienna, Austria.
authors: Peter
authors: P
authors: Schellongowski
authors: Intensive Care Unit 13 H1, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Austria.
authors: Ulrike
authors: U
authors: Holzinger
authors: Intensive Care Unit 13 H1, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Austria.
authors: Christian
authors: C
authors: Zauner
authors: Intensive Care Unit 13 H3, Department of Cardiology, Division of Internal Medicine II, Medical University of Vienna, Austria.
authors: Gottfried
authors: G
authors: Heinz
authors: Department of Gastroenterology and Hepatology, KA Rudolfstiftung, Austria.
authors: Christian
authors: C
authors: Madl
authors: Intensive Care Unit 13 H1, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Austria.
authors: Michael
authors: M
authors: Trauner
authors: Intensive Care Unit 13 H1, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Austria. Electronic address: v.fuhrmann@gmx.at.
authors: Valentin
authors: V
authors: Fuhrmann
mesh_terms: D000368:Aged; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D006505:Hepatitis / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D000860:Hypoxia / Q000401:mortality* / Q000517:prevention & control*; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015427:Reperfusion Injury / Q000401:mortality / Q000517:prevention & control; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Incidence; Intensive care unit; Ischemic liver injury; Outcome; Prophylaxis