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Association of the Use of HMG-CoA Reductase Inhibitors During Sepsis With Sepsis Outcomes FREE TO VIEW

Julio Pinto Corrales*, MD; Erics Espinoza Moscoso, MD; Charles Makowski, PharmD; Michael Peters, RPh; Daniel Ouellette, MD
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Henry Ford Hospital, Detroit, MI

Chest. 2012;142(4_MeetingAbstracts):283A. doi:10.1378/chest.1383517
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SESSION TYPE: Sepsis/Shock

PRESENTED ON: Sunday, October 21, 2012 at 10:30 AM - 11:45 AM

PURPOSE: It is well known that HMG-CoA reductase inhibitors (HMGCoA) improve outcomes in patients with coronary artery disease, mainly because anti-inflammatory, inmunomodulatory and anti-thrombotic properties. Such properties conceivably could lead to salutary benefits in other conditions such as sepsis. We utilized an institutional quality improvement sepsis database to learn if the use of HMGCoA was associated with outcomes in septic patients.

METHODS: A retrospective review of a quality improvement sepsis database from a single institution was performed. Patients who received HMGCoA during sepsis (group A) were compared to those that did not (group B). Subjects were included only once in the analysis, with the first sepsis event being chosen when there were multiple events. The two groups were compared, with the Chi-square test being used for categorical variables and the Student’s t-test used for continuous variables. Risk factors associated with mortality were sought in Groups A and B by employing first univariate and then multivariate logistic regression analysis (SPSS). Significance was considered to be present for p<0.05.

RESULTS: The study group included 1661 patients with 327 in group A and 1334 in group B. The mortality rate in group A was 24.5% and in group B was 30.8% (80/327, 411/1334, p<0.05). Patients in Group A were older than those in Group B (68.6 years versus 61.4 years, p<0.001), but were otherwise similar demographically. Group A patients had similar APACHE II scores and resuscitation parameters compared to Group B, but had lower lactate levels (3.35 mmol/L versus 4.04 mmol/L, p<0.001). Parameters associated with mortality by multivariate logistic regression analysis (p<0.05) included: gender, APACHE II score, age, a lactate level >4 mmol/L, hematocrit, intubation within the first 24 hours, and HMGCoA use.

CONCLUSIONS: HMG-CoA use during sepsis was associated with reduced mortality in a retrospective single center study. HMGCoA recipients had reduced lactate levels when compared to other patients.

CLINICAL IMPLICATIONS: We suggest that HMGCoA use may affect inflammation and improve oxygen utilization during sepsis.

DISCLOSURE: The following authors have nothing to disclose: Julio Pinto Corrales, Erics Espinoza Moscoso, Charles Makowski, Michael Peters, Daniel Ouellette

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Henry Ford Hospital, Detroit, MI




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