PURPOSE: Recent studies suggest that HMG-CoA reductase inhibitors (“statins”), angiotensin converting enzyme (ACE) inhibitors, and angiotensin II receptor blockers (ARB) reduce systemic inflammation, and may be associated with improved survival for patients at risk for some types of infections. Our aim was to examine the effect of prior outpatient statin, ARB, and ACE inhibitor use on 30-day mortality for patients hospitalized with sepsis.
METHODS: A retrospective cohort study using Veterans Health Administration (VA) administrative data of patients hospitalized with sepsis in 18 of 21 networks in fiscal year 2000. Patients were included if they were at least 65 years of age, had a discharge ICD-9 diagnosis for sepsis, at least 1 year of VA primary care prior to hospitalization, and at least 1 filled VA medication within 90 days of admission. The dependent variable was 30-day mortality. The primary analysis was a generalized linear mixed-effect model with hospital as a random effect, and control variables including comorbid conditions, demographics, and other medications.
RESULTS: We identified 3018 patients hospitalized with sepsis that met our inclusion/exclusion criteria. The mean age was 74 years, 98.5% were male, and 27% of patients died within 30-days of presentation. Regarding medication use 16% of patients were taking statins, 35% ACE inhibitors, and 4% ARBs within 90-days of hospital presentation. In the primary analysis, statin use (odds ratio 0.48, 95% confidence interval 0.4-0.6) and ARB use (0.42, 0.2-0.8), but not ACE inhibitor use (0.98, 0.8-1.2), were significantly associated with decreased 30-day mortality.
CONCLUSION: Current outpatient statin and ARB use at presentation is associated with decreased mortality in patients hospitalized with sepsis.
CLINICAL IMPLICATIONS: Sepsis-related mortality could be potentially reduced by the use of these medications in patients hospitalized with sepsis, pending further confirmatory studies.
DISCLOSURE: Eric Mortensen, Product/procedure/technique that is considered research and is NOT yet approved for any purpose, the use of statins and angiotensin II receptor blockers for sepsis is not FDA approved.