title: Sepsis outcomes in patients receiving statins prior to hospitalization for sepsis: comparison of in-hospital mortality rates between patients who received atorvastatin and those who received simvastatin.
abstract: BACKGROUND
  The purpose of this study is to compare the in-hospital mortality rates between septic patients receiving statins and those that did not prior to developing sepsis. We compared subgroups receiving atorvastatin and simvastatin because these two drugs differ in their pharmacologic properties.
  
  
  METHODS
  This study was a retrospective analysis of patients selected from an institutional data base of patients hospitalized with sepsis. The study patients were drawn from a data base of 1,961 hospitalized patients with sepsis and included patients who met selection criteria and who were studied for HMG-CoA reductase inhibitor (statin) use both prior to and during hospitalization. The in-hospital mortality rates of patients receiving statins and those that did not prior to developing sepsis were compared. In-hospital mortality rates of patient subgroups receiving atorvastatin and simvastatin were also compared. A multivariable analysis was conducted with in-hospital mortality as the outcome variable and with multiple risk factors to include atorvastatin and simvastatin use.
  
  
  RESULTS
  The mortality rate for 359 patients receiving statins prior to hospitalization for sepsis was not significantly different than that for 1,302 patients who did not receive pre-hospital statins (26.5% versus 30.4%, p > 0.05). The mortality rate for 92 patients who had received atorvastatin prior to hospitalization was significantly less than that of 253 patients who received simvastatin (18.5% versus 30.0%, p = 0.032). The use of atorvastatin prior to sepsis was independently associated with lower in-hospital mortality in a multivariable analysis of sepsis risk factors (p = 0.021, OR = 0.455). Patients who received atorvastatin prior to hospitalization for sepsis and had statins continued in hospital had a very low mortality rate that was significantly less than that of those patients who never received statins (15.7% versus 30.8%, p = 0.007).
  
  
  CONCLUSIONS
  Pre-hospital atorvastatin use was associated with improved in-hospital mortality in septic patients when compared with pre-hospital simvastatin use and was independently associated with an improved outcome when compared to other sepsis risk factors. The effect of statins in patients with sepsis may be different for individual statins.
authors.affiliation: Pulmonary and Critical Care Medicine, Henry Ford Hospital, K-17, 2799 West Grand Blvd, 48202 Detroit, MI USA.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Ouellette
authors.affiliation: Pulmonary and Critical Care Medicine, Henry Ford Hospital, K-17, 2799 West Grand Blvd, 48202 Detroit, MI USA.
authors.forename: Erics Espinoza
authors.initials: EE
authors.lastname: Moscoso
authors.affiliation: Pulmonary and Critical Care Medicine, Henry Ford Hospital, K-17, 2799 West Grand Blvd, 48202 Detroit, MI USA.
authors.forename: Julio Pinto
authors.initials: JP
authors.lastname: Corrales
authors.affiliation: Department of Pharmacy, Henry Ford Hospital, K-17, 2799 West Grand Blvd, 48202 Detroit, MI USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Peters
keywords: Atorvastatin; Critical illness; HMG-CoA reductase inhibitors; Inflammation; Mortality; Sepsis