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2015 ; 13
(ä): 128
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Impact of statin therapy on mortality in patients with sepsis-associated acute
respiratory distress syndrome (ARDS) depends on ARDS severity: a prospective
observational cohort study
#MMPMID26033076
Mansur A
; Steinau M
; Popov AF
; Ghadimi M
; Beissbarth T
; Bauer M
; Hinz J
BMC Med
2015[Jun]; 13
(ä): 128
PMID26033076
show ga
BACKGROUND: Previous investigations have presumed a potential therapeutic effect
of statin therapy in patients with acute respiratory distress syndrome (ARDS).
Statins are expected to attenuate inflammation in the lungs of patients with ARDS
due to their anti-inflammatory effects. Clinical investigations of the role of
statin therapy have revealed contradictory results. This study aimed to
investigate whether pretreatment and continuous therapy with statins in patients
with sepsis-associated ARDS are associated with 28-day survival according to
disease severity (mild, moderate, or severe). METHODS: Patients with
sepsis-associated ARDS from the surgical intensive care were enrolled in this
prospective observational investigation. ARDS was classified into three groups
(mild, moderate, and severe); 28-day mortality was recorded as the primary
outcome variable and organ failure was recorded as secondary outcome variable.
Sequential Organ Failure Assessment scores and the requirements for organ support
were evaluated throughout the observational period to assess organ failure.
RESULTS: 404 patients with sepsis-associated ARDS were enrolled in this
investigation. The distribution of the ARDS subgroups was 13 %, 59 %, and 28 %
for mild, moderate, and severe disease, respectively. Statin therapy improved
28-day survival exclusively in the patients with severe ARDS compared with
patients without statin therapy (88.5 % and 62.5 %, respectively; P = 0.0193). To
exclude the effects of several confounders, we performed multivariate Cox
regression analysis, which showed that statin therapy remained a significant
covariate for mortality (hazard ratio, 5.46; 95 % CI, 1.38-21.70; P = 0.0156).
Moreover, after carrying a propensity score-matching in the severe ARDS cohort,
Kaplan-Meier survival analysis confirmed the improved 28-day survival among
patients with statin therapy (P = 0.0205). Patients with severe ARDS who received
statin therapy had significantly more vasopressor-free days compared with those
without statin therapy (13 ± 7 and 9 ± 7, respectively; P = 0.0034), and they
also required less extracorporeal membrane oxygenation (ECMO) therapy and had
more ECMO-free days (18 ± 9 and 15 ± 9, respectively; P = 0.0873). CONCLUSIONS:
This investigation suggests a beneficial effect of continuous statin therapy in
patients with severe sepsis-associated ARDS and a history of prior statin
therapy. Further study is warranted to elucidate this potential effect.
|Adult
[MESH]
|Aged
[MESH]
|Cohort Studies
[MESH]
|Female
[MESH]
|Humans
[MESH]
|Hydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic use
[MESH]