title: Continuation of Statin Therapy and Vasopressor Use in Septic Shock.
abstract: BACKGROUND
  Studies have evaluated the use of statins in sepsis; however, no human studies have explored their effect on vasopressor requirements in septic shock.
  
  
  OBJECTIVE
  The primary objective was to determine the effect of prehospital statin continuation on duration of vasopressor therapy in patients with septic shock. Secondary objectives included maximum and average vasopressor dose and in-hospital mortality.
  
  
  METHODS
  This was a retrospective, institutional board-approved, observational cohort study in a community teaching hospital; 119 adult intensive care unit (ICU) patients with an ICD-9 code for septic shock and prehospital statin therapy were evaluated. Multivariate analyses were performed to address confounders.
  
  
  RESULTS
  Of the 1229 patients screened, 119 (10%) met inclusion criteria; 73 patients (61%) had a statin continued within 24 hours of ICU admission. Crude analysis demonstrated no difference in vasopressor duration in the statin versus no statin group (3.3 vs 4.8 days; P = 0.21). There was no difference in either maximum (17.9 ± 16.1 vs 23.8 ± 21.7 µg/min norepinephrine equivalents [NEQs]; P = 0.1) or average vasopressor dose (9.5 ± 8.4 vs 12.1 ± 11.5 µg/min NEQ; P = 0.17). There was a decrease in mortality in the statin patients (43% vs 67 %; P = 0.05). On adjustment for potential confounders, there was no difference in any outcome, with a persistent trend toward lower mortality in the statin group.
  
  
  CONCLUSIONS
  Continuation of prehospital statin therapy decreased neither duration nor dose of vasopressors in patients with septic shock but yielded a trend toward decreased mortality.
authors.affiliation: Spectrum Health Department of Pharmacy, Grand Rapids, MI, USA Carrie.Zechmeister@spectrumhealth.org.
authors.forename: Carrie
authors.initials: C
authors.lastname: Zechmeister
authors.affiliation: St John Hospital and Medical Center Department of Pharmacy, Detroit, MI, USA.
authors.forename: Jeff
authors.initials: J
authors.lastname: Hurren
authors.affiliation: St John Hospital and Medical Center Department of Pharmacy, Detroit, MI, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: McNorton
mesh_terms: D000368:Aged; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007362:Intensive Care Units; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009638:Norepinephrine / Q000627:therapeutic use; D010865:Pilot Projects; D012189:Retrospective Studies; D012772:Shock, Septic / Q000188:drug therapy* / Q000401:mortality; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D014662:Vasoconstrictor Agents; D009638:Norepinephrine
keywords: hydroxymethylglutaryl-CoA reductase inhibitors; immunomodulation; sepsis; septic; shock; systemic inflammatory response syndrome; vasopressors