PURPOSE: Sepsis develops as a result of release of several proinflammatory molecules that cause endothelial cell damage that can eventually lead to multi organ failure and death. Statins have shown antiinflammatory effect by multilevel actions in the inflammatory cascade, and also play an important role in optimization of endothelial cell function. We aim to analyze the association of statin therapy and hospital mortality in patients with severe sepsis and septic shock.
METHODS: Retrospective observational cohort study of consecutive adults (≥ 18 years) with severe sepsis and septic shock admitted to a medical intensive care unit of a tertiary care academic hospital from January 2007 until December 2009. Patients presenting with mixed shock states or lack of research authorization were excluded. All patients underwent an institutional protocol for early goal-directed therapy (EGDT). Diagnosis of severe sepsis or septic shock was based on the definitions by the International Sepsis Definitions Conference. To determine the independent association of statin therapy and mortality in severe sepsis and septic shock patients, we created a multiple logistic regression model by adjusting for the propensity score for the use of statin therapy (based on comorbid conditions), and covariates identified in the univariate analysis.
RESULTS: A total of 651 patients with severe sepsis and septic shock were included in the study, of which 217 patients were on statin therapy. The median (interquartile range [IQR]) age of this cohort was 77 (65-81) and 60% were male. The median (IQR) Acute Physiologic and Chronic Health Evaluation III score (APACHE III) was 56 (43-71). When adjusted for probability of taking statins, age, severity of illness predicted by APACHE III, Do Not Resuscitate status, and Charlson score; statin therapy was associated with a decreased risk of hospital mortality (odds ratio 0.51, 95% Confidence interval 0.31-0.81).
CONCLUSIONS: In this retrospective cohort study of severe sepsis and septic shock patients undergoing an institutional protocol of EGDT, statin therapy was associated with markedly decreased risk of hospital mortality.
CLINICAL IMPLICATIONS: Improvement in mortality of severe sepsis and septic patients.
DISCLOSURE: The following authors have nothing to disclose: Anil Paturi, Juan Carlos Valerio-Rojas, Rahul Kashyap, Insara Jaffer Sathick, Arun Subramanian, Rodrigo Cartin-Ceba
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