PURPOSE:To determine if current statin therapy is associated with a decrease in mortality among patients hospitalized with sepsis compared to remote or no statin use.
METHODS:We retrospectively identified a cohort of 23,587 patients aged 50 or older hospitalized with sepsis or severe sepsis between 1/1/99 and 12/31/04. The cohort was divided into 3 groups based on statin use: current users (on statin on the day of hospitalization), remote users (statin use up to 2 months prior to hospitalization but none thereafter) and nonusers (no statin use in the 12 months prior to hospitalization). Sepsis was identified by primary discharge diagnosis ICD-9 codes of 0.38.x (Septicemia), 995.91 (Sepsis), 995.92 (SIRS), 785.52 (septic shock), 785.5 (unspecified shock) and 518.5 (ARDS) that was coded in conjunction with a secondary severity code. Random chart review showed the PPVs for the sepsis codes and statin use were 87% and 90%, respectively. Each patient was followed for up to 12 months after the index admission or until death. We analyzed the 12-month mortality rates adjusting for baseline characteristics and major comorbidities, including the Charlson index.
RESULTS:The mean age of the cohort was 72 ± 10 years and 52% were male; 70% were statin nonusers, 11% remote users and 19% current users. Statin users had more comorbidities and higher Charlson scores. Adjusting for age and gender only, the all cause mortality HR of current users and remote users compared to nonusers were 0.78 (95% CI 0.74–0.82) and 0.97 (95% CI 0.91–1.03), respectively. In the fully adjusted models, the HR of current users versus nonusers was 0.85 (95% CI 0.78–0.93), the HR of current versus remote users was 0.80 (95% CI 0.75–0.85).
CONCLUSION:Among patients hospitalized with sepsis, current statin use is associated with a statistically significant lower rate of one year mortality compared to nonusers and remote users.
CLINICAL IMPLICATIONS:In this retrospective observation, statins were associated with reduced mortality in patients with sepsis. Prospective controlled studies appear warranted.
DISCLOSURE:Ahmed Ijaz Shah, No Financial Disclosure Information; No Product/Research Disclosure Information