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Yu SS, Jin J, Yao RQ, Wang BL, Hu LY, Wu GS, Sun Y. Association of Preadmission Statin Use and Mortality in Critically Ill Patients: A Meta-Analysis of Cohort Studies. Front Med (Lausanne) 2021; 8:656694. [PMID: 34124094 PMCID: PMC8193232 DOI: 10.3389/fmed.2021.656694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/05/2021] [Indexed: 01/11/2023] Open
Abstract
Background: A large number of studies have been conducted to determine whether there is an association between preadmission statin use and improvement in outcomes following critical illness, but the conclusions are quite inconsistent. Therefore, this meta-analysis aims to include the present relevant PSM researches to examine the association of preadmission use of statins with the mortality of critically ill patients. Methods: The PubMed, Web of Science, Embase electronic databases, and printed resources were searched for English articles published before March 6, 2020 on the association between preadmission statin use and mortality in critically ill patients. The included articles were analyzed in RevMan 5.3. The Newcastle-Ottawa Scale (NOS) was used to conduct quality evaluation, and random/fixed effects modeling was used to calculate the pooled ORs and 95% CIs. We also conducted subgroup analysis by outcome indicators (30-, 90-day, hospital mortality). Results: All six PSM observational studies were assessed as having a low risk of bias according to the NOS. For primary outcome-overall mortality, the pooled OR (preadmission statins use vs. no use) across the six included studies was 0.86 (95% CI, 0.76-0.97; P = 0.02). For secondary outcome-use of mechanical ventilation, the pooled OR was 0.94 (95% CI, 0.91-0.97; P = 0.0005). The corresponding pooled ORs were 0.67 (95% CI, 0.43-1.05; P = 0.08), 0.91 (95% CI, 0.83-1.01; P = 0.07), and 0.86 (95% CI, 0.83-0.89; P < 0.00001) for 30-, 90-day, and hospital mortality, respectively. Conclusions: Preadmission statin use is associated with beneficial outcomes in critical ill patients, indicating a lower short-term mortality, less use of mechanical ventilation, and an improvement in hospital survival. Further high-quality original studies or more scientific methods are needed to draw a definitive conclusion.
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Affiliation(s)
- Shao-Shuo Yu
- Department of Burn Surgery, Changhai Hospital, The Naval University, Shanghai, China
| | - Jian Jin
- Department of Burn and Plastic Surgery, 903rd Hospital of the Chinese People's Liberation Army (PLA), Hangzhou, China
| | - Ren-Qi Yao
- Department of Burn Surgery, Changhai Hospital, The Naval University, Shanghai, China
| | - Bo-Li Wang
- Department of Burn Surgery, Changhai Hospital, The Naval University, Shanghai, China
| | - Lun-Yang Hu
- Department of Burn Surgery, Changhai Hospital, The Naval University, Shanghai, China
| | - Guo-Sheng Wu
- Department of Burn Surgery, Changhai Hospital, The Naval University, Shanghai, China
| | - Yu Sun
- Department of Burn Surgery, Changhai Hospital, The Naval University, Shanghai, China
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Azkarate I, Díez M, Ganzarain M, Salas E, Choperena G, Eguibar I. Statin therapy prior to hospitalization does not significantly influence sepsis presentation or sepsis outcomes. A prospective, observational study. Med Clin (Barc) 2020; 156:13-16. [PMID: 32402386 DOI: 10.1016/j.medcli.2020.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/31/2020] [Accepted: 02/27/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND In addition to being effective at lowering cholesterol, statins seem to have immunomodulatory, antimicrobial, antioxidant and anticoagulant effects. OBJECTIVE To determine whether the presentation of sepsis and its outcome in patients who have had prehospital statin therapy are different. METHODS A prospective, observational study was carried out on 1042 septic patients, for 5 consecutive years in the Intensive Care Unit (ICU) of a tertiary hospital. RESULTS 317 (30.4%) septic patients were receiving statins prior to hospitalization. Patients on statin therapy were older (69.7 years old vs 62.5; p <.001), males (71.9% vs 65.7%; p=.047) and with a higher mean Acute Physiology and Chronic Health Evaluation (APACHE) II score (21.7 vs 20.1; p<.001). Renal dysfunction was observed in a greater proportion (60.3% vs 51.5%; p=.009) in statin users but without requiring more continuous renal replacement therapies (CRRT). No differences were observed in Sequential Organ Failure Assessment (SOFA) score, procalcitonin levels, source of infection, microorganism and nosocomial infections in ICU and hospital mortality or length of stay. CONCLUSIONS Statin therapy prior to hospitalization does not significantly influence sepsis presentation or sepsis outcomes.
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Affiliation(s)
- Izaskun Azkarate
- Servicio de Medicina Intensiva, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España.
| | - Mikel Díez
- Servicio de Medicina Intensiva, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - Maialen Ganzarain
- Servicio de Medicina Intensiva, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - Estibaliz Salas
- Servicio de Medicina Intensiva, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - Gabriel Choperena
- Servicio de Medicina Intensiva, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - Itziar Eguibar
- Servicio de Medicina Intensiva, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
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3
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Parihar SP, Guler R, Brombacher F. Statins: a viable candidate for host-directed therapy against infectious diseases. Nat Rev Immunol 2019; 19:104-117. [PMID: 30487528 DOI: 10.1038/s41577-018-0094-3] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Statins were first identified over 40 years ago as lipid-lowering drugs and have been remarkably effective in treating cardiovascular diseases. As research advanced, the protective effects of statins were additionally attributed to their anti-inflammatory, antioxidative, anti-thrombotic and immunomodulatory functions rather than lipid-lowering abilities alone. By promoting host defence mechanisms and inhibiting pathological inflammation, statins increase survival in human infectious diseases. At the cellular level, statins inhibit the intermediates of the host mevalonate pathway, thus compromising the immune evasion strategies of pathogens and their survival. Here, we discuss the potential use of statins as an inexpensive and practical alternative or adjunctive host-directed therapy for infectious diseases caused by intracellular pathogens, such as viruses, protozoa, fungi and bacteria.
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Affiliation(s)
- Suraj P Parihar
- International Centre for Genetic Engineering and Biotechnology (ICGEB), Cape Town-Component, Cape Town, South Africa. .,Institute of Infectious Diseases and Molecular Medicine (IDM), Department of Pathology, Division of Immunology and South African Medical Research Council (SAMRC), Immunology of Infectious Diseases, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. .,Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa) and Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. .,Division of Medical Microbiology, Department of Pathology, University of Cape Town, Cape Town, South Africa.
| | - Reto Guler
- International Centre for Genetic Engineering and Biotechnology (ICGEB), Cape Town-Component, Cape Town, South Africa.,Institute of Infectious Diseases and Molecular Medicine (IDM), Department of Pathology, Division of Immunology and South African Medical Research Council (SAMRC), Immunology of Infectious Diseases, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa) and Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Frank Brombacher
- International Centre for Genetic Engineering and Biotechnology (ICGEB), Cape Town-Component, Cape Town, South Africa. .,Institute of Infectious Diseases and Molecular Medicine (IDM), Department of Pathology, Division of Immunology and South African Medical Research Council (SAMRC), Immunology of Infectious Diseases, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. .,Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa) and Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
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4
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Zheng X, Zhang W, Wang Z. Simvastatin preparations promote PDGF-BB secretion to repair LPS-induced endothelial injury through the PDGFRβ/PI3K/Akt/IQGAP1 signalling pathway. J Cell Mol Med 2019; 23:8314-8327. [PMID: 31576676 PMCID: PMC6850957 DOI: 10.1111/jcmm.14709] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 08/14/2019] [Accepted: 08/29/2019] [Indexed: 01/11/2023] Open
Abstract
Endothelial barrier dysfunction is a critical pathophysiological process of sepsis. Impaired endothelial cell migration is one of the main reasons for endothelial dysfunction. Statins may have a protective effect on endothelial barrier function. However, the effect and mechanism of statins on lipopolysaccharide (LPS)‐induced endothelial barrier dysfunction remain unclear. Simvastatin (SV) was loaded in nanostructured lipid carriers to produce SV nanoparticles (SV‐NPs). Normal SV and SV‐NPs were used to treat human umbilical vein vascular endothelial cells (HUVECs) injured by LPS. Barrier function was evaluated by monitoring cell monolayer permeability and transendothelial electrical resistance, and cell migration ability was measured by a wound healing assay. LY294002 and imatinib were used to inhibit the activity of PI3K/Akt and platelet‐derived growth factor receptor (PDGFR) β. IQ‐GTPase‐activating protein 1 (IQGAP1) siRNA was used to knockdown endogenous IQGAP1, which was used to verify the role of the PDGFRβ/PI3K/Akt/IQGAP1 pathway in SV/SV‐NPs‐mediated barrier protection in HUVECs injured by LPS. The results show that SV/SV‐NPs promoted the migration and decreased the permeability of HUVECs treated with LPS, and the efficacy of the SV‐NPs exceeded that of SV significantly. LY294002, imatinib and IQGAP1 siRNA all suppressed the barrier protection of SV/SV‐NPs. SV/SV‐NPs promoted the secretion of platelet‐derived growth factor‐BB (PDGF‐BB) and activated the PDGFRβ/PI3K/Akt/IQGAP1 pathway. SV preparations restored endothelial barrier function by restoring endothelial cell migration, which is involved in the regulation of the PDGFRβ/PI3K/Akt/IQGAP1 pathway and PDGF‐BB secretion. As an appropriate formulation for restoring endothelial dysfunction, SV‐NPs may be more effective than SV.
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Affiliation(s)
- Xia Zheng
- Department of Critical Care Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Wang Zhang
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Zhen Wang
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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5
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Neto RNM, de Barros Gomes E, Weba-Soares L, Dias LRL, da Silva LCN, de Miranda RDCM. Biotechnological Production of Statins: Metabolic Aspects and Genetic Approaches. Curr Pharm Biotechnol 2019; 20:1244-1259. [PMID: 31333127 DOI: 10.2174/1389201020666190718165746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 07/06/2019] [Accepted: 07/07/2019] [Indexed: 11/22/2022]
Abstract
Statins are drugs used for people with abnormal lipid levels (hyperlipidemia) and are among the best-selling medications in the United States. Thus, the aspects related to the production of these drugs are of extreme importance for the pharmaceutical industry. Herein, we provide a non-exhaustive review of fungal species used to produce statin and highlighted the major factors affecting the efficacy of this process. The current biotechnological approaches and the advances of a metabolic engineer to improve statins production are also emphasized. The biotechnological production of the main statins (lovastatin, pravastatin and simvastatin) uses different species of filamentous fungi, for example Aspergillus terreus. The statins production is influenced by different types of nutrients available in the medium such as the carbon and nitrogen sources, and several researches have focused their efforts to find the optimal cultivation conditions. Enzymes belonging to Lov class, play essential roles in statin production and have been targeted to genetic manipulations in order to improve the efficiency for Lovastatin and Simvastatin production. For instance, Escherichia coli strains expressing the LovD have been successfully used for lovastatin production. Other examples include the use of iRNA targeting LovF of A. terreus. Therefore, fungi are important allies in the fight against hyperlipidemias. Although many studies have been conducted, investigations on bioprocess optimization (using both native or genetic- modified strains) still necessary.
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Affiliation(s)
- Roberval N M Neto
- Pro-reitoria de Pos-Graduacao, Pesquisa e Extensao, Universidade Ceuma, Sao Luis, Maranhao, Brazil
| | | | - Lucas Weba-Soares
- Pro-reitoria de Pos-Graduacao, Pesquisa e Extensao, Universidade Ceuma, Sao Luis, Maranhao, Brazil
| | - Léo R L Dias
- Pro-reitoria de Pos-Graduacao, Pesquisa e Extensao, Universidade Ceuma, Sao Luis, Maranhao, Brazil
| | - Luís C N da Silva
- Pro-reitoria de Pos-Graduacao, Pesquisa e Extensao, Universidade Ceuma, Sao Luis, Maranhao, Brazil
| | - Rita de C M de Miranda
- Pro-reitoria de Pos-Graduacao, Pesquisa e Extensao, Universidade Ceuma, Sao Luis, Maranhao, Brazil
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Kyriazopoulou E, Giamarellos-Bourboulis EJ. Pharmacological management of sepsis in adults with a focus on the current gold standard treatments and promising adjunctive strategies: evidence from the last five years. Expert Opin Pharmacother 2019; 20:991-1007. [DOI: 10.1080/14656566.2019.1589451] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Evdoxia Kyriazopoulou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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