1
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Xu Q, Zheng B, Shen P, Xiao Y. Protective efficacy of statins in patients with Klebsiella pneumoniae bloodstream infection. Front Cell Infect Microbiol 2023; 12:1087701. [PMID: 36683706 PMCID: PMC9849249 DOI: 10.3389/fcimb.2022.1087701] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/08/2022] [Indexed: 01/06/2023] Open
Abstract
Background Patients with bloodstream infection of Klebsiella pneumoniae (BSI-KP) have a high risk of death and septic shock. This study aims to identify the risk factors for mortality and severity in patients of BSI-KP. Methods Data of BSI-KP patients were extracted from the MIMIC IV (Medical Information Mart for Intensive Care IV) database, and patients infected with only K. pneumoniae in blood were included in this study. The risk factors of 28-day mortality and septic shock in BSI-KP patients were analyzed, respectively. Results A total of 279 patients enrolled and the all-cause 28-day mortality rate was 11.8%. The use of statins (OR 0.220, 95% CI 0.060-0.801, p = 0.022) and quinolones (OR 0.356, 95% CI 0.143-0.887, p = 0.027) were both independent protective factors for death within 28 days, while the use of vasoactive drugs (OR 7.377, 95% CI 1.775-30.651, p = 0.006) was a risk factor. Besides, pulmonary disease (OR 2.348, 95% CI 1.126-4.897, p = 0.023), bleeding and coagulation disorders (OR 3.626, 95% CI 1.783-7.372, p < 0.001), respiratory failure (OR 2.823, 95% CI 0.178-6.767, p = 0.020) and kidney dysfunction (OR 2.450, 95% CI 1.189-5.047, p = 0.015) were independent risk factors for patients suffered from septic shock while hypertension was a protective one. The receiver operating characteristic (ROC) curves could well predict the risk of death within 28-day (area under ROC = 0.855, 95% CI = 0.796-0.914, p < 0.001) and septic shock (AUROC = 0.815, 95% CI = 0.755-0.874, p < 0.001) in patients with BSI-KP. Conclusion The use of statins could decrease the risk of 28-day mortality in patients of BSI-KP. The risk factor-based prediction model provided evidence for drug treatment in BSI-KP patients. Paying more attention to the strategy of drug treatment will be an optimal way to improve patient's outcome in clinical practice.
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Affiliation(s)
- Qian Xu
- Laboratory Medicine Center, Department of Transfusion Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang Province, China,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, Zhejiang Province, China
| | - Beiwen Zheng
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, Zhejiang Province, China
| | - Ping Shen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, Zhejiang Province, China,Jinan Microecological Biomedicine Shandong Laboratory, Jinan, Shandong Province, China
| | - Yonghong Xiao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, Zhejiang Province, China,*Correspondence: Yonghong Xiao,
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2
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Hsu CH, Chen HP, Chen PL, Chan YJ. Detection of influenza and non-influenza respiratory viruses in lower respiratory tract specimens among hospitalized adult patients and analysis of the clinical outcome. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2022; 55:820-828. [PMID: 34974992 DOI: 10.1016/j.jmii.2021.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 11/23/2021] [Accepted: 12/06/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Lower respiratory tract infection (LRTI) is one of the most fatal diseases for adults. Influenza is a well-recognized cause of severe pneumonia; however, the outcomes of LRTI caused by non-influenza respiratory viruses (NIRVs) have not been sufficiently investigated. This study aimed to describe the characteristics and outcomes of LRTI associated with respiratory viruses (RVs) in adults. MATERIALS/METHODS A retrospective review was performed using medical records of adult patients whose lower respiratory tract (LRT) specimens (endotracheal aspirate and bronchoalveolar lavage fluid) tested positive for RVs using multiplex PCR. Underlying comorbidities, laboratory data, and clinical outcomes were analyzed. RESULTS Among the 808 LRT specimens collected from 666 adult patients, RV was identified in 115 specimens (14%) from 106 patients (16%). The underlying comorbidities and laboratory data did not differ between patients with influenza- and NIRV-related LRTI. The 14-day and 30-day mortality rates were higher in the influenza group than in the NIRV group (24% versus 7%, p = 0.03 and 33% versus 13%, p = 0.02, respectively), whereas the 90-day mortality rate did not. In a multivariate Cox model to predict 90-day mortality, shock and acute kidney injury independently predicted a higher mortality rate (hazard ratio (HR): 4.28, 95% CI: 1.46-12.58, p = 0.01 and HR: 2.80, 95% CI: 1.28-6.15, p = 0.01, respectively), whereas the detection of influenza did not. CONCLUSIONS Influenza and NIRVs were associated with increased mortality due to LRTI in adults. Therefore, NIRVs are among key pathogens causing LRTI and should not be neglected by clinicians.
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Affiliation(s)
- Ching-Hao Hsu
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsin-Pai Chen
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Po-Liang Chen
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Jiun Chan
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Microbiology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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3
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TANYELİ A, EKİNCİ AKDEMİR FN, ERASLAN E, GÜLER MC, ÖZBEK ŞEBİN S, GÜLÇİN İ. The possible useful effectiveness of sinapic acid in secondary organ damage sepsis-induced in rats. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.864015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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4
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Inandiklioglu N, Doganyigit Z, Okan A, Kaymak E, Silici S. Nephroprotective effect of apilarnil in lipopolysaccharide-induced sepsis through TLR4/NF-κB signaling pathway. Life Sci 2021; 284:119875. [PMID: 34384831 DOI: 10.1016/j.lfs.2021.119875] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/26/2021] [Accepted: 08/05/2021] [Indexed: 01/20/2023]
Abstract
AIMS In this study, we aimed to investigate the protective effect of apilarnil on kidney damage in the sepsis model induced by LPS. MAIN METHODS 64 Sprague Dawley adult male rats were randomly divided into eight groups; control group, groups in which 0.2, 0.4 and 0.8 g/kg/bw apilarnil (API) was applied by oral gavage method for 10 days, LPS group in which 30 mg/kg/bw lipopolysaccharide (LPS) administered as intraperitoneally, groups in which LPS + 0.2, LPS+ 0.4 and LPS +0,8 API was applied. Six hour after the last administration the rats were anesthetized for euthanasia and kidney tissues were removed for RT-PCR analysis, immunohistochemical analysis and histopathologic analysis. KEY FINDING According to the results of RT-PCR expression levels of IL-6, IL-1β, NF-κB, TNF-α and TLR4 were significantly reduced in the LPS + 0,8 API group. Immunoreactivity of TLR4, pNF-κB and TNF-α levels in the LPS + 0.8 apilarnil group were significantly lower than in the LPS and LPS + 0.2 apilarnil groups. Histologically, compared to the LPS group the glomerular damage score tended to decrease in the LPS + 0,4 API and LPS+ 0,8 API groups, while the tubulointerstitial injury score decreased especially in the LPS + 0,8 API group. SIGNIFICANCE In the present study, 0,8 g/kg dose of apilarnil promoted potential renoprotective effects which were achieved, at least in part, by the modulation of important markers of the local immune response in the model of LPS-induced sepsis.
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Affiliation(s)
- Nihal Inandiklioglu
- Department of Medical Biology, Faculty of Medicine, Yozgat Bozok University, Yozgat, Turkey.
| | - Züleyha Doganyigit
- Department of Histology and Embryology, Faculty of Medicine, Yozgat Bozok University, Yozgat, Turkey
| | - Aslı Okan
- Department of Histology and Embryology, Faculty of Medicine, Yozgat Bozok University, Yozgat, Turkey
| | - Emin Kaymak
- Department of Histology and Embryology, Faculty of Medicine, Yozgat Bozok University, Yozgat, Turkey
| | - Sibel Silici
- Department of Agricultural Biotechnology, Faculty of Agriculture, Erciyes University, Kayseri, Turkey
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5
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Iqbal Z, Ho JH, Adam S, France M, Syed A, Neely D, Rees A, Khatib R, Cegla J, Byrne C, Qureshi N, Capps N, Ferns G, Payne J, Schofield J, Nicholson K, Datta D, Pottle A, Halcox J, Krentz A, Durrington P, Soran H. Managing hyperlipidaemia in patients with COVID-19 and during its pandemic: An expert panel position statement from HEART UK. Atherosclerosis 2020; 313:126-136. [PMID: 33045618 PMCID: PMC7490256 DOI: 10.1016/j.atherosclerosis.2020.09.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/02/2020] [Accepted: 09/08/2020] [Indexed: 02/06/2023]
Abstract
The emergence of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which causes Coronavirus Disease 2019 (COVID-19) has resulted in a pandemic. SARS-CoV-2 is highly contagious and its severity highly variable. The fatality rate is unpredictable but is amplified by several factors including advancing age, atherosclerotic cardiovascular disease, diabetes mellitus, hypertension and obesity. A large proportion of patients with these conditions are treated with lipid lowering medication and questions regarding the safety of continuing lipid-lowering medication in patients infected with COVID-19 have arisen. Some have suggested they may exacerbate their condition. It is important to consider known interactions with lipid-lowering agents and with specific therapies for COVID-19. This statement aims to collate current evidence surrounding the safety of lipid-lowering medications in patients who have COVID-19. We offer a consensus view based on current knowledge and we rated the strength and level of evidence for these recommendations. Pubmed, Google scholar and Web of Science were searched extensively for articles using search terms: SARS-CoV-2, COVID-19, coronavirus, Lipids, Statin, Fibrates, Ezetimibe, PCSK9 monoclonal antibodies, nicotinic acid, bile acid sequestrants, nutraceuticals, red yeast rice, Omega-3-Fatty acids, Lomitapide, hypercholesterolaemia, dyslipidaemia and Volanesorsen. There is no evidence currently that lipid lowering therapy is unsafe in patients with COVID-19 infection. Lipid-lowering therapy should not be interrupted because of the pandemic or in patients at increased risk of COVID-19 infection. In patients with confirmed COVID-19, care should be taken to avoid drug interactions, between lipid-lowering medications and drugs that may be used to treat COVID-19, especially in patients with abnormalities in liver function tests.
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Affiliation(s)
- Zohaib Iqbal
- Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Jan Hoong Ho
- Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Safwaan Adam
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom,The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Michael France
- Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Akheel Syed
- Department of Diabetes, Endocrinology and Obesity Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Dermot Neely
- Department of Blood Sciences and NIHR MedTech and IVD Centre, Newcastle Upon Tyne Hospitals, Newcastle Upon Tyne, United Kingdom
| | - Alan Rees
- HEART UK, Maidenhead, United Kingdom
| | - Rani Khatib
- Departments of Cardiology & Pharmacy, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom,Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Jaimini Cegla
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, 6th Floor Commonwealth Building, Hammersmith Hospital, Du Cane Road, W12 0NN, London, United Kingdom
| | - Christopher Byrne
- Department of Nutrition and Metabolism, Faculty of Medicine, University of Southampton, United Kingdom
| | - Nadeem Qureshi
- Division of Primary Care, University of Nottingham, Nottingham, United Kingdom
| | - Nigel Capps
- The Shrewsbury and Telford Hospital NHS Trust, United Kingdom
| | - Gordon Ferns
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, United Kingdom
| | | | - Jonathan Schofield
- Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Kirsty Nicholson
- Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Dev Datta
- Department of Metabolic Medicine, University Hospital of Wales, Cardiff, United Kingdom
| | - Alison Pottle
- Department of Cardiology, Harefield Hospital, United Kingdom
| | - Julian Halcox
- Department of Medicine, Swansea University, Swansea, United Kingdom
| | - Andrew Krentz
- Institute of Cardiovascular & Metabolic Research, University of Reading, United Kingdom
| | - Paul Durrington
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Handrean Soran
- Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom; Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.
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6
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Zeenny RM, Mansour H, Kabbara WK, Chamoun N, Audi M, Yared Y, Salameh P. Effects of statins on clinical outcomes in hospitalized patients with community-acquired pneumonia. J Int Med Res 2020; 48:300060520938586. [PMID: 32780619 PMCID: PMC7557788 DOI: 10.1177/0300060520938586] [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] [Indexed: 12/29/2022] Open
Abstract
Objective We evaluated the effect of chronic use of statins based on C-reactive protein (CRP) levels and hospital length of stay (LOS) in patients admitted with community-acquired pneumonia (CAP). Methods We conducted a retrospective study over 12 months at a teaching hospital in Lebanon comparing patients with CAP taking chronic statins with patients not taking statins. Included patients with CAP were older than age 18 years and had two CRP level measures during hospitalization. CURB-65 criteria were used to assess the severity of pneumonia. A decrease in CRP levels on days 1 and 3, LOS, and normalization of fever were used to assess the response to antibiotics. Results Sixty-one patients were taking statins and 90 patients were not taking statins. Patients on statins had significantly more comorbid conditions; both groups had comparable CURB-65 scores. In both groups, no statistically significant difference was seen for the decrease in CRP level on days 1 and 3 and LOS. No difference in days to normalization of fever was detected in either group. Conclusion No association was found between the chronic use of statins and CRP levels, LOS, or days to fever normalization in patients with CAP.
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Affiliation(s)
- Rony M Zeenny
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Hanine Mansour
- Lebanese American University, School of Pharmacy, Byblos, Lebanon
| | - Wissam K Kabbara
- Lebanese American University, School of Pharmacy, Byblos, Lebanon
| | - Nibal Chamoun
- Lebanese American University, School of Pharmacy, Byblos, Lebanon
| | - Myriam Audi
- Lebanese American University, School of Pharmacy, Byblos, Lebanon.,Pharmacy Manager, Pharmacie Aoude, Jounieh, Lebanon
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7
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Protective Effect of a Novel (2S, 3R, 4S)-Chromene-3-Carboxamide Derivative, Z20 Against Sepsis-Induced Organ Injury. Inflammation 2020; 43:1222-1232. [DOI: 10.1007/s10753-019-01174-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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8
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Cheng CY, Kung CT, Chen FC, Cheng HH, Tsai TC, Hsiao SY, Su CM. Impact of prior statin use on mortality in patients with type 2 diabetes mellitus and bloodstream infection. J Int Med Res 2019; 47:3636-3647. [PMID: 31234680 PMCID: PMC6726825 DOI: 10.1177/0300060519856137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Objective This study assessed the effect of prior statin use on the 28-day mortality of patients with type 2 diabetes mellitus (DM) who develop bloodstream infections. Methods This retrospective cohort study included all adult type 2 DM patients with bacteremia and verified prior medication history who visited the emergency department of a single tertiary hospital between January 2007 and December 2013. All major adverse consequences including septic shock events, use of mechanical ventilation, intensive care unit admission, and 28-day mortality were assessed. Results A total of 1,979 patients were enrolled in the study, of whom 507 were taking statins. Statin users had less severe disease presentation and lower levels of sepsis biomarkers such as bandemia (1.3 ± 3.1 vs 1.8 ± 4.2). After adjustment for confounding variables using a Cox regression model, only older age (adjusted hazard ratio [HR]: 1.04, 95% confidence interval [CI], 1.01–1.04), urinary tract infection (adjusted HR: 0.56, 95% CI, 0.43–0.75), and prior statin use (adjusted HR: 0.58, 95% CI: 0.42–0.85) were significantly associated with 28-day in-hospital mortality. Conclusion Prior statin treatment in patients with type 2 DM and bacteremia was associated with a lower 28-day in-hospital mortality rate.
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Affiliation(s)
- Chi-Yung Cheng
- 1 Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Republic of China
| | - Chia-Te Kung
- 1 Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Republic of China
| | - Fu-Cheng Chen
- 1 Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Republic of China
| | - Hsien-Hung Cheng
- 1 Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Republic of China
| | - Tsung-Cheng Tsai
- 1 Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Republic of China
| | - Sheng-Yuan Hsiao
- 1 Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Republic of China
| | - Chih-Min Su
- 1 Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Republic of China.,2 School of Medicine, Chung Shan Medical University, Taichung, Republic of China
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9
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Hu SY, Hsieh MS, Lin TC, Liao SH, Hsieh VCR, Chiang JH, Chang YZ. Statins improve the long-term prognosis in patients who have survived sepsis: A nationwide cohort study in Taiwan (STROBE complaint). Medicine (Baltimore) 2019; 98:e15253. [PMID: 31027074 PMCID: PMC6831426 DOI: 10.1097/md.0000000000015253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Most patients diagnosed with sepsis died during their first episode, with the long-term survival rate upon post-sepsis discharge being low. Major adverse cardiovascular events and recurrent infections were regarded as the major causes of death. No definite medications had proven to be effective in improving the long-term prognosis. We aimed to examine the benefits of statins on the long-term prognosis of patients who had survived sepsis.Between 1999 and 2013, a total of 220,082 patients who had been hospitalized due to the first episode of sepsis were included, with 134,448 (61.09%) of them surviving to discharge. The surviving patients who were subsequently prescribed statins at a concentration of more than 30 cumulative Defined Daily Doses (cDDDs) during post-sepsis discharge were defined as the users of statin.After a propensity score matching ratio of 1:5, a total of 7356 and 36,780 surviving patients were retrieved for the study (statin users) and comparison cohort (nonstatin users), respectively. The main outcome was to determine the long-term survival rate during post-sepsis discharge.HR with 95% CI was calculated using the Cox regression model to evaluate the effectiveness of statins, with further stratification analyses according to cDDDs.The users of statins had an adjusted HR of 0.29 (95% CI, 0.27-0.31) in their long-term mortality rate when compared with the comparison cohort. For the users of statins with cDDDs of 30-180, 180-365, and >365, the adjusted HRs were 0.32, 0.22, and 0.16, respectively, (95% CI, 0.30-0.34, 0.19-0.26, and 0.12-0.23, respectively), as compared with the nonstatins users (defined as the use of statins <30 cDDDs during post-sepsis discharge), with the P for trend <.0001. In the sensitivity analysis, after excluding the surviving patients who had died between 3 and 6 months after post-sepsis discharge, the adjusted HR for the users of statins remained significant (0.35, 95% CI 0.32-0.37 and 0.42, 95% CI 0.39-0.45, respectively).Statins may have the potential to decrease the long-term mortality of patients who have survived sepsis. However, more evidence, including clinical and laboratory data, is necessary in order to confirm the results of this observational cohort study.Trial registration: CMUH104-REC2-115.
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Affiliation(s)
- Sung-Yuan Hu
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung
- Institute of Medicine, Chung Shan Medical University, Taichung
- School of Medicine, Chung Shan Medical University, Taichung
- Department of Nursing, College of Health, National Taichung University of Science and Technology, Taichung
- Department of Nursing, Central Taiwan University of Science and Technology, Taichung
- Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli County
- School of Medicine, National Yang-Ming University, Taipei
| | - Ming-Shun Hsieh
- School of Medicine, National Yang-Ming University, Taipei
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, College of Public Health, Taipei
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan
| | - Tzu-Chieh Lin
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung
- School of Medicine, Chung Shan Medical University, Taichung
- College of Public Health, China Medical University, Taichung
| | - Shu-Hui Liao
- Department of Pathology and Laboratory, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan
| | | | - Jen-Huai Chiang
- Department of Health Services Administration, China Medical University, Taichung
| | - Yan-Zin Chang
- Institute of Medicine, Chung Shan Medical University, Taichung
- Department of Clinical Laboratory, Drug Testing Center, Chung Shan Medical University Hospital, Taichung, Taiwan
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10
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Braga Filho JAF, Abreu AG, Rios CEP, Trovão LO, Silva DLF, Cysne DN, Nascimento JR, Fortes TS, Silva LA, Guerra RNM, Maciel MCG, Serezani CH, Nascimento FRF. Prophylactic Treatment With Simvastatin Modulates the Immune Response and Increases Animal Survival Following Lethal Sepsis Infection. Front Immunol 2018; 9:2137. [PMID: 30298072 PMCID: PMC6160584 DOI: 10.3389/fimmu.2018.02137] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 08/30/2018] [Indexed: 01/09/2023] Open
Abstract
Chronic use of statins may have anti-inflammatory action, promoting immunomodulation and survival in patients with sepsis. This study aimed to analyze the effects of pretreatment with simvastatin in lethal sepsis induced by cecal ligation and puncture (CLP). Male Swiss mice received prophylactic treatment with simvastatin or pyrogen-free water orally in a single daily dose for 30 days. After this period, the CLP was performed. Naïve and Sham groups were performed as non-infected controls. Animal survival was monitored for 60 h after the CLP. Half of mice were euthanized after 12 h to analyze colony-forming units (CFUs); hematological parameters; production of IL-10, IL-12, IL-6, TNF-α, IFN-γ, and MCP-1; cell counts on peritoneum, bronchoalveolar lavage (BAL), bone marrow, spleen, and mesenteric lymph node; immunephenotyping of T cells and antigen presenting cells and production of hydrogen peroxide (H2O2). Simvastatin induced an increase in survival and a decrease in the CFU count on peritoneum and on BAL cells number, especially lymphocytes. There was an increase in the platelets and lymphocytes number in the Simvastatin group when compared to the CLP group. Simvastatin induced a greater activation and proliferation of CD4+ T cells, as well as an increase in IL-6 and MCP-1 production, in chemotaxis to the peritoneum and in H2O2 secretion at this site. These data suggest that simvastatin has an impact on the survival of animals, as well as immunomodulatory effects in sepsis induced by CLP in mice.
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Affiliation(s)
- Jose A F Braga Filho
- Laboratory of Immunophysiology, Federal University of Maranhão, São Luís, Brazil
| | - Afonso G Abreu
- Programa de Pós-Graduação em Ciências da Saúde, Federal University of Maranhão, São Luís, Brazil.,CEUMA University, São Luís, Brazil
| | - Carlos E P Rios
- Laboratory of Immunophysiology, Federal University of Maranhão, São Luís, Brazil
| | - Liana O Trovão
- Laboratory of Immunophysiology, Federal University of Maranhão, São Luís, Brazil
| | - Dimitri Luz F Silva
- Laboratory of Immunophysiology, Federal University of Maranhão, São Luís, Brazil
| | - Dalila N Cysne
- Laboratory of Immunophysiology, Federal University of Maranhão, São Luís, Brazil
| | - Johnny R Nascimento
- Laboratory of Immunophysiology, Federal University of Maranhão, São Luís, Brazil.,Programa de Pós-Graduação em Ciências da Saúde, Federal University of Maranhão, São Luís, Brazil
| | - Thiare S Fortes
- Laboratory of Immunophysiology, Federal University of Maranhão, São Luís, Brazil.,Programa de Pós-Graduação em Ciências da Saúde, Federal University of Maranhão, São Luís, Brazil
| | - Lucilene A Silva
- Laboratory of Immunophysiology, Federal University of Maranhão, São Luís, Brazil
| | - Rosane N M Guerra
- Laboratory of Immunophysiology, Federal University of Maranhão, São Luís, Brazil.,Programa de Pós-Graduação em Ciências da Saúde, Federal University of Maranhão, São Luís, Brazil
| | - Márcia C G Maciel
- Programa de Pós-Graduação em Ciências da Saúde, Federal University of Maranhão, São Luís, Brazil
| | - Carlos H Serezani
- Division of Infectious Diseases, Departments of Medicine, Pathology, Microbiology and Immunology, Institute for Infection, Immunology and Inflammation, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Flávia R F Nascimento
- Laboratory of Immunophysiology, Federal University of Maranhão, São Luís, Brazil.,Programa de Pós-Graduação em Ciências da Saúde, Federal University of Maranhão, São Luís, Brazil
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11
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Policardo L, Seghieri G, Gualdani E, Franconi F. Effect of statins in preventing hospitalizations for infections: A population study. Pharmacoepidemiol Drug Saf 2018; 27:878-884. [PMID: 29808503 DOI: 10.1002/pds.4557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/24/2018] [Accepted: 04/13/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE To investigate whether the hospitalization rate for bacterial infections was modified by statin therapy in a population retrospectively followed up, over years 2011 to 2015. METHODS By using administrative databases, the 5-year hospitalization rate due to bacterial infections in population living in Tuscany, Italy exposed to statin therapy (n = 52,049) was stratified by 5 prescribed daily doses classes (0%-20%, 20%-50%, 50%-80%, 80%-100%, ≥100% of DDD) and subsequently compared with that of a population of untreated individuals (n = 3 300 ,675), matched through a propensity score accounting for all available covariates potentially able to modulate risk of infections such as age, gender, previous hospitalizations for infections, cardiovascular events, previous co-morbidities, diabetes, as well as general practitioners' proactive behaviour of care delivery according to current guidelines. RESULTS Unmatched individuals of each treatment-class had significantly more hospitalizations than controls, while matched treated people, apart from those in class 0% to 20%, had a decrease of hospitalizations, as large as the increase in prescribed drug. Statin effect in reducing hospitalizations translated into a number needed to treat (NNT) ranging across treatment strata from 102 to 54. CONCLUSIONS Compliance to statin prescribed daily doses above the threshold 20% of DDD, along a 5-year follow-up, prevented hospitalizations due to infectious diseases in a large unselected population, after adjusting for covariates able to modulate baseline risk of infections. The NNTs to avoid 1 hospitalization for infections resulted on average not too dissimilar from a value lying between the 95% CI of NNTs previously found for primary prevention of 1 incident coronary ischemic event (72 to 119).
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Affiliation(s)
- Laura Policardo
- Epidemiology Unit, Regional Health Agency of Tuscany, Florence, Italy
| | - Giuseppe Seghieri
- Epidemiology Unit, Regional Health Agency of Tuscany, Florence, Italy
| | - Elisa Gualdani
- Epidemiology Unit, Regional Health Agency of Tuscany, Florence, Italy
| | - Flavia Franconi
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
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12
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da Silva KLC, Camacho AP, Mittestainer FC, Carvalho BM, Santos A, Guadagnini D, Oliveira AG, Saad MJA. Atorvastatin and diacerein reduce insulin resistance and increase disease tolerance in rats with sepsis. JOURNAL OF INFLAMMATION-LONDON 2018; 15:8. [PMID: 29760586 PMCID: PMC5944072 DOI: 10.1186/s12950-018-0184-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 04/30/2018] [Indexed: 12/30/2022]
Abstract
Background Sepsis is one of the leading causes of death among hospitalized patients. At the onset of this condition, there is an over-production of pro-inflammatory mediators that contribute to organ failure and death. The excess production of pro-inflammatory mediators also impairs insulin signaling, which may be a pathophysiological tissue marker of proinflammatory cytokine action before organ failure. Statins and diacerein have pleiotropic effects, such as the blockage of inflammatory signaling pathways, suggesting that these drugs may be an attractive therapeutic or prophylactic strategy against sepsis. The aim of the present study was to investigate whether a statin or diacerein can improve insulin signaling, disease tolerance and survival in sepsis by inhibiting inflammatory pathways. Methods We investigated the effect of these drugs on survival, tissue insulin signaling and inflammatory pathways in the liver and muscle of rats with sepsis induced by cecal ligation and puncture (CLP). Results The results showed that administration of medications, with anti-inflammatory ability, to septic animals increased survival and improved disease tolerance and insulin resistance in the liver and muscle. The treatment also attenuated ER stress, NF-κB, JNK activation and restored glucose-6-phosphatase (G6Pase) levels in the liver. Conclusions Our results indicate that atorvastatin and diacerein treatment can modulate inflammatory pathways and, in parallel, attenuate insulin resistance in sepsis. Since these two drugs have safety profiles and minimal side effects, we suggest that these drugs may be alternative therapies for the prevention or therapies for the treatment of insulin resistance in sepsis, which could potentially reduce mortality in patients with sepsis. Electronic supplementary material The online version of this article (10.1186/s12950-018-0184-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- K L C da Silva
- 1Department of Internal Medicine, State University of Campinas, Campinas, SP Brazil
| | - A P Camacho
- 1Department of Internal Medicine, State University of Campinas, Campinas, SP Brazil
| | - F C Mittestainer
- 1Department of Internal Medicine, State University of Campinas, Campinas, SP Brazil
| | - B M Carvalho
- 2Department of Biology Science, Federal University of Pernambuco, Recife, PE Brazil
| | - A Santos
- 1Department of Internal Medicine, State University of Campinas, Campinas, SP Brazil.,Departamento de Clínica Médica, FCM-UNICAMP, Cidade Universitária Zeferino Vaz, Campinas, SP 13083-887 Brazil
| | - D Guadagnini
- 1Department of Internal Medicine, State University of Campinas, Campinas, SP Brazil
| | - A G Oliveira
- 3Department of Physical Education, São Paulo State University (UNESP), Bioscience Institute, Rio Claro, SP Brazil
| | - M J A Saad
- 1Department of Internal Medicine, State University of Campinas, Campinas, SP Brazil.,Departamento de Clínica Médica, FCM-UNICAMP, Cidade Universitária Zeferino Vaz, Campinas, SP 13083-887 Brazil
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13
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Watkinson PJ, Barber VS, Young JD. Outcome of Critically ill Patients Undergoing Mandatory Insulin Therapy Compared to Usual Care Insulin Therapy: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2018. [PMID: 29519778 PMCID: PMC5865000 DOI: 10.2196/resprot.5912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Observational and interventional studies in patients with both acute medical conditions and long-standing diabetes have shown that improved blood glucose control confers a survival advantage or reduces complication rates. Policies of “tight” glycaemic control were rapidly adopted by many general intensive care units (ICUs) worldwide in the mid 00’s, even though the results of the studies were not generalizable to mixed medical/surgical ICUs with different intravenous feeding policies. Objective The primary objective of the study is to assess the safety of mandatory insulin infusion in critically ill patients in a general ICU setting. Methods This protocol summarizes the rationale and design of a randomized, controlled, single-center trial investigating the effect of mandatory insulin therapy versus usual care insulin therapy for those patients admitted for a stay of longer than 48 hours. In total, 109 critically ill adults predicted to stay in intensive care for longer than 48 hours consented. The primary outcome is to determine the safety of mandatory insulin therapy in critically ill patients using the number of episodes of hypoglycaemia and hypokalaemia per unit length of stay in intensive care. Secondary outcomes include the duration of mechanical ventilation, duration of ICU and hospital stay, hospital mortality, and measures of renal, hepatic, and haematological dysfunction. Results The project was funded in 2005 and enrolment was completed 2007. Data analysis is currently underway and the first results are expected to be submitted for publication in 2018. Conclusions This protocol for a randomized controlled trial investigating the effect of mandatory insulin therapy should provide an answer to a key question for the management of patients in the ICU and ultimately improving outcome. Trial Registration International Standard Randomized Controlled Trial Number ISRCTN00550641; http://www.isrctn.com/ISRCTN00550641 (Archived at WebCite: http://www.webcitation.org/6xk8NXxNv).
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Affiliation(s)
- Peter J Watkinson
- Critical Care Trials Group, University of Oxford, Oxford, United Kingdom
| | - Vicki S Barber
- Oxford Clinical Trials Research Unit, University of Oxford, Oxford, United Kingdom
| | - J Duncan Young
- Critical Care Trials Group, University of Oxford, Oxford, United Kingdom
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Policardo L, Seghieri G, Anichini R, Francesconi P. Effect of statins on hospitalization risk of bacterial infections in patients with or without diabetes. Acta Diabetol 2017; 54:669-675. [PMID: 28421335 DOI: 10.1007/s00592-017-0990-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 03/31/2017] [Indexed: 01/09/2023]
Abstract
AIMS To investigate whether statins reduce the risk to first hospitalization of bacterial infections, in patients with or without diabetes taking into account prior or incident comorbidities. METHODS By using administrative databases, the effect of current statin use was measured on the risk of first hospitalizations due to bacterial infections in people living in Tuscany, Italy, in the period January 1, 2011-December 31, 2015, after excluding those with previous statins use. Population was stratified as with (n = 128,207) or without diabetes (n = 3,304,906), and the hospitalization risk was analyzed by a Cox proportional hazards regression analysis after adjusting for age, gender, previous comorbidities, chronic renal failure, and prior or incident cardiovascular diseases. RESULTS During the 5-year follow-up, 31,543 hospitalizations for bacterial infections were observed: 2.08(2.06-2.10) per 1000 person-year in non-diabetic and 5679: 9.13(8.94-9.32) per 1000 person-year in diabetic population. Diabetes conferred a greater risk of hospitalizations, independently from confounders [adjusted HR (95% CI) 2.04 (1.97-2.10); P < 0.0001]. Statin use decreased the risk by about 2.5% for each one month of therapy, at the same extent in subjects with or without diabetes, after adjusting for all covariates. CONCLUSIONS In this population, diabetes was associated by a twofold increase in the 5-year risk of hospitalizations for bacterial infections. Statin use decreased this risk to a same extent in subjects without or with diabetes, after adjusting for main confounders including comorbidities, and previous or incident cardiovascular events.
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Affiliation(s)
- Laura Policardo
- Epidemiology Unit, Agenzia Regionale Sanità Toscana, Via Pietro Dazzi 1, 50141, Florence, Italy
| | - Giuseppe Seghieri
- Epidemiology Unit, Agenzia Regionale Sanità Toscana, Via Pietro Dazzi 1, 50141, Florence, Italy.
| | | | - Paolo Francesconi
- Epidemiology Unit, Agenzia Regionale Sanità Toscana, Via Pietro Dazzi 1, 50141, Florence, Italy
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15
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Abstract
Objective: To systematically review the evidence evaluating the role of statin therapy in sepsis. Data Sources: MEDLINE, EMBASE, and PubMed were searched (1980–January 2007) for English-language clinical trials that evaluated the use of statins and the development and treatment of sepsis in human subjects. Search terms included statin, HMG-CoA reductase inhibitor, bacteremia, sepsis, septic shock, septicemia, and severe sepsis. In addition, pertinent references from identified articles were obtained. Study Selection and Data Extraction: Only clinical trials with primary efficacy outcomes of mortality, incidence of sepsis, and severe sepsis were included. Data Synthesis: Seven retrospective and 2 prospective cohort studies were included in this review. One was excluded because the patient population was not experiencing sepsis. Three studies demonstrated a reduced mortality with statin use while 2 other studies did not demonstrate this mortality benefit. One study suggested increased mortality with statin use in sepsis. Three studies showed a reduced incidence of development of sepsis or sepsis-related outcomes, while one study did not. The observational and retrospective nature of these studies and the higher rate of cardiovascular comorbidities in the statin groups may have allowed for a confounding influence. The conflicting results and heterogeneity between the studies makes the observed association between statin use and incidence of sepsis and sepsis-related mortality inconclusive. The clinical benefit of statin therapy in sepsis remains to be determined. Conclusions: There is an association between statin use and a lower incidence of sepsis and sepsis-related mortality. However, a causal relationship between stalin use and reduced sepsis-related mortality has not yet been established. Currently, statins cannot be recommended for sepsis prevention or treatment until controlled trials are performed.
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Affiliation(s)
- Doson Chua
- St. Paul's Hospital, Vancouver, BC, Canada.
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16
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Nassaji M, Ghorbani R, Afshar RK. The Effect of Statins Use on the Risk and Outcome of Acute Bacterial Infections in Adult Patients. J Clin Diagn Res 2015; 9:OC09-12. [PMID: 26676277 DOI: 10.7860/jcdr/2015/14538.6773] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 08/12/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Beyond their lipid-lowering abilities, statins have anti-inflammatory and immunomodulatory properties. In view of these effects, a growing interest has emerged in the possible role of statins, in preventing or decreasing morbidity and mortality from infection. OBJECTIVES The aim of this study was to determine whether previous statin use is associated with reduced risk of acute bacterial infections and better outcome of these infections. MATERIALS AND METHODS In this historical cohort study, consecutive adult patients admitted with acute bacterial infection were enrolled. Control group were selected from adult outpatient and without history of acute bacterial infections. Acute bacterial infections included in this study were; pneumonia, acute pyelonephritis, cellulitis and sepsis with unknown origin. Data about baseline characteristics, co-morbidities and statins use of two groups was obtained. RESULTS Finally 144 patients met inclusion criteria and were enrolled. Same numbers of controls were selected. Two groups were matched based on most baseline characteristics and co-morbidities. The patients' categories were as follows: pneumonia 42.3%, acute pyelonephritis 23.6%, cellulitis 16% and sepsis 18%. From all participants 29.9% of patients and 45.8% controls were statin users. There was significant association between previous statin use and reduced risk of acute bacterial infections (Mantel Haenszel Weighted Odds Ratio=0.51, 95% CI: 0.30-0.85, p=0.009). Duration of hospitalization was significantly shorter in statin users (p=0.002). Hospital mortality rate was lower (14.6%) in statins users when compared with non-users (18.8%) with significant difference (p=0.028). CONCLUSION Prior therapy with statins is associated with considerably reduced onset of acute bacterial infections and better outcome in adult patients.
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Affiliation(s)
- Mohammad Nassaji
- Associate Professor, Department of Infectious Disease, Social Determinants of Health Research Center, Faculty of Medicine, Semnan University of Medical Sciences , Semnan, Iran
| | - Raheb Ghorbani
- Professor of Biostatistics, Department of Community Medicine, Social Determinants of Health Research Center, Faculty of Medicine, Semnan University of Medical Sciences , Semnan, Iran
| | - Reza Kiaee Afshar
- General Physician, Department of Internal Medicine, Semnan University of Medical Sciences , Semnan, Iran
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Wang HE, Griffin R, Shapiro NI, Howard G, Safford MM. Chronic Statin Use and Long-Term Rates of Sepsis: A Population-Based Cohort Study. J Intensive Care Med 2014; 31:386-96. [PMID: 25223827 DOI: 10.1177/0885066614550280] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 04/18/2014] [Indexed: 01/14/2023]
Abstract
PURPOSE "Statins" have immunomodulatory and anti-inflammatory effects and may attenuate the risk of infections. We sought to determine the association between chronic statin use and long-term rates of sepsis events. MATERIALS AND METHODS We used data from 30 183 adult (≥45 years old) community-dwelling participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. The primary exposure was statin use. The primary outcome was hospitalization or emergency department treatment for sepsis. Using Cox proportional hazards models, we determined associations between statin use and first sepsis events, adjusting for patients demographics, health behaviors, chronic medical conditions, degree of medication adherence, baseline high-sensitivity C-reactive protein (hsCRP), and propensity for statin use. RESULTS Approximately one-third of participants reported statin use (n = 9475, 31.4%). During the 10-year follow-up period from 2003 to 2012, there were 1500 incident sepsis events. Statin use was not associated with rates of sepsis after multivariable adjustment for demographics, health behaviors, chronic medical conditions, medication adherence, abnormal hsCRP, and propensity for statin use, hazard ratio 0.93 (95% confidence interval: 0.81-1.06). Statin use was not similarly associated with rates of sepsis when stratified by propensity for statin use or medication adherence. CONCLUSION In the REGARDS cohort, statin use at baseline was not associated with rates of future sepsis events.
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Affiliation(s)
- Henry E Wang
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, USA
| | - Russell Griffin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Monika M Safford
- Division of Preventive Medicine, Department of Medicine, University of Alabama School of Medicine, Birmingham, AL, USA
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18
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Etienne D, Reda Y. Statins and their role in acute pancreatitis: Case report and literature review. World J Gastrointest Pharmacol Ther 2014; 5:191-195. [PMID: 25133048 PMCID: PMC4133445 DOI: 10.4292/wjgpt.v5.i3.191] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 06/20/2014] [Accepted: 06/27/2014] [Indexed: 02/06/2023] Open
Abstract
Statin induced pancreatitis has historically been considered a diagnosis of exclusion, with literature references typically in the form of case reports and observational studies. Recently, larger studies have challenged the correlations made by earlier case reports, and instead demonstrate a mild protective effect in statin users. We present a case report of likely statin induced pancreatitis in a 58-year-old male (which we have attributed to drug-drug interaction with resulting inhibition of hepatic cytochrome P450 enzymes) and have reviewed the apparent dichotomy in the available literature.
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19
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Truwit JD, Bernard GR, Steingrub J, Matthay MA, Liu KD, Albertson TE, Brower RG, Shanholtz C, Rock P, Douglas IS, deBoisblanc BP, Hough CL, Hite RD, Thompson BT. Rosuvastatin for sepsis-associated acute respiratory distress syndrome. N Engl J Med 2014; 370:2191-200. [PMID: 24835849 PMCID: PMC4241052 DOI: 10.1056/nejmoa1401520] [Citation(s) in RCA: 387] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND In the acute respiratory distress syndrome (ARDS), inflammation in the lungs and other organs can cause life-threatening organ failure. Inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A reductase (statins) can modulate inflammatory responses. Previous observational studies suggested that statins improved clinical outcomes in patients with sepsis. We hypothesized that rosuvastatin therapy would improve clinical outcomes in critically ill patients with sepsis-associated ARDS. METHODS We conducted a multicenter trial in which patients with sepsis-associated ARDS were randomly assigned to receive either enteral rosuvastatin or placebo in a double-blind manner. The primary outcome was mortality before hospital discharge home or until study day 60 if the patient was still in a health care facility. Secondary outcomes included the number of ventilator-free days (days that patients were alive and breathing spontaneously) to day 28 and organ-failure-free days to day 14. RESULTS The study was stopped because of futility after 745 of an estimated 1000 patients had been enrolled. There was no significant difference between study groups in 60-day in-hospital mortality (28.5% with rosuvastatin and 24.9% with placebo, P=0.21) or in mean (±SD) ventilator-free days (15.1±10.8 with rosuvastatin and 15.1±11.0 with placebo, P=0.96). The groups were well matched with respect to demographic and key physiological variables. Rosuvastatin therapy, as compared with placebo, was associated with fewer days free of renal failure to day 14 (10.1±5.3 vs. 11.0±4.7, P=0.01) and fewer days free of hepatic failure to day 14 (10.8±5.0 vs. 11.8±4.3, P=0.003). Rosuvastatin was not associated with an increased incidence of serum creatine kinase levels that were more than 10 times the upper limit of the normal range. CONCLUSIONS Rosuvastatin therapy did not improve clinical outcomes in patients with sepsis-associated ARDS and may have contributed to hepatic and renal organ dysfunction. (Funded by the National Heart, Lung, and Blood Institute and the Investigator-Sponsored Study Program of AstraZeneca; ClinicalTrials.gov number, NCT00979121.).
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20
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Dobesh PP, Olsen KM. Statins role in the prevention and treatment of sepsis. Pharmacol Res 2014; 88:31-40. [PMID: 24794878 DOI: 10.1016/j.phrs.2014.04.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 04/21/2014] [Accepted: 04/22/2014] [Indexed: 12/23/2022]
Abstract
Sepsis is a complex disease with typically poor outcomes. While the onset of sepsis is typically infectious, the detrimental consequences follow pathogen toxin release that produces activation of numerous cytokines and a pro-inflammatory response. These same cytokines also stimulate activation of coagulation and inhibit natural fibrinolysis. Despite decades of research targeted against these pathways the development of sepsis and mortality in patients with sepsis remains high. While statins were developed for reducing cholesterol in patients with atherosclerotic disease, we now know they have a number of other properties which may be helpful in the prevention and treatment of sepsis. Statins have demonstrated the ability to reduce a number of pro-inflammatory cytokines known to be detrimental in the development and progression of sepsis. Statins have also demonstrated the ability to limit the coagulation response and promote fibrinolysis in the setting of sepsis. Based on these encouraging pharmacologic properties of statins a number of trials have been conducted evaluating the impact of statins on the prevention and treatment of sepsis. Most of the trials to date have been retrospective cohort trials, with very few prospective randomized trials. While some trials fail to demonstrate a benefit of statins, most trials suggest a reduction in the development of sepsis and/or other important sepsis related outcomes. While the laboratory and early clinical experience with statins are encouraging, randomized controlled trials will be need to fully define the role of statins in the prevention and treatment of sepsis.
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Affiliation(s)
- Paul P Dobesh
- Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, 986045 Nebraska Medical Center, Omaha, NE 68198-6045, USA.
| | - Keith M Olsen
- Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, 986045 Nebraska Medical Center, Omaha, NE 68198-6045, USA.
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21
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Wan YD, Sun TW, Kan QC, Guan FX, Zhang SG. Effect of statin therapy on mortality from infection and sepsis: a meta-analysis of randomized and observational studies. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:R71. [PMID: 24725598 PMCID: PMC4056771 DOI: 10.1186/cc13828] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 03/25/2014] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Observational data have suggested that statin therapy may reduce mortality in patients with infection and sepsis; however, results from randomized studies are contradictory and do not support the use of statins in this context. Here, we performed a meta-analysis to investigate the effects of statin therapy on mortality from infection and sepsis. METHODS We searched electronic databases (PubMed and Embase) for articles published before November 2013. Randomized or observational studies reporting the effects of statin therapy on mortality in patients with infection or sepsis were eligible. Randomized and observational studies were separately pooled with relative risks (RRs) and random-effects models. RESULTS We examined 5 randomized controlled trials with 867 patients and 27 observational studies with 337,648 patients. Among the randomized controlled trials, statins did not significantly decrease in-hospital mortality (RR, 0.98; 95% confidence interval (CI), 0.73 to 1.33) or 28-day mortality (RR, 0.93; 95% CI, 0.46 to 1.89). However, observational studies indicated that statins were associated with a significant decrease in mortality with adjusted data (RR, 0.65; 95% CI, 0.57 to 0.75) or unadjusted data (RR, 0.74; 95% CI, 0.59 to 0.94). CONCLUSIONS Limited evidence suggests that statins may not be associated with a significant reduction in mortality from infection and sepsis. Although meta-analysis from observational studies showed that the use of statins was associated with a survival advantage, these outcomes were limited by high heterogeneity and possible bias in the data. Therefore, we should be cautious about the use of statins in infection and sepsis.
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Amir D, Fessler DMT. Boots for Achilles: progesterone's reduction of cholesterol is a second-order adaptation. QUARTERLY REVIEW OF BIOLOGY 2013; 88:97-116. [PMID: 23909226 DOI: 10.1086/670528] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Progesterone and cholesterol are both vital to pregnancy. Among other functions, progesterone downregulates inflammatory responses, allowing for maternal immune tolerance of the fetal allograft. Cholesterol a key component of cell membranes, is important in intracellular transport, cell signaling, nerve conduction, and metabolism Despite the importance of each substance in pregnancy, one exercises an antagonistic effect on the other, as periods of peak progesterone correspond with reductions in cholesterol availability, a consequence of progesterone's negative effects on cholesterol biosynthesis. This arrangement is understandable in light of the threat posed by pathogens early in pregnancy. Progesterone-induced immunomodulation entails increased vulnerability to infection, an acute problem in the first trimester, when fetal development is highly susceptible to insult. Many pathogens rely on cholesterol for cell entry, egress, and replication. Progesterone's antagonistic effects on cholesterol thus partially compensate for the costs entailed by progesterone-induced immunomodulation. Among pathogens to which the host's vulnerability is increased by progesterone's effects, approximately 90% utilize cholesterol, and this is notably true of pathogens that pose a risk during pregnancy. In addition to having a number of possible clinical applications, our approach highlights the potential importance of second-order adaptations, themselves a consequence of the lack of teleology in evolutionary processes.
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Affiliation(s)
- Dorsa Amir
- Center for Behavior, Evolution, and Culture, Department of Anthropology, University of California, Los Angeles Los Angeles, California 90095-1553, USA.
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Trezzi M, Blackstone EH, Sun Z, Li L, Sabik JF, Lytle BW, Gordon SM, Koch CG. Statin therapy is associated with fewer infections after cardiac operations. Ann Thorac Surg 2013; 95:892-900. [PMID: 23380476 DOI: 10.1016/j.athoracsur.2012.11.071] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 10/30/2012] [Accepted: 11/27/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND Statins interact with multiple pathways involved in infection. Therefore, we examined the association between preoperative statin therapy and infections after cardiac operations and assessed whether statin therapy was associated with lower infection-related mortality. METHODS From January 2005 to January 2011, 12,741 patients underwent cardiac operations. Endpoints were (1) postoperative infections and (2) mortality after an infectious complication. A propensity score was developed on the probability of patients receiving statin therapy; patients were matched in part on this score. A multivariable logistic model was developed to examine mortality. Survival of infected patients was estimated using Kaplan-Meier and multiphase hazard function methodology. RESULTS A total of 6,113 patients (48%) were receiving statins and 6,628 (52%) were not. Five hundred fifteen patients had postoperative infections-260 (4.3%) in the statin group and 255 (3.8%) in the no-statin group. However, patients receiving statins were older with more comorbidities and less favorable operative characteristics. Among propensity-matched groups, postoperative infections were significantly lower in patients receiving statins (n = 102 [3.1%]) than in those who were not (n = 147 [4.5%]; p = 0.004). Among patients in whom infections developed, there was no significant difference in hospital mortality between the statin and no-statin groups either before or after propensity-score matching (odds ratio, 1.38; confidence limit [CL], 0.59, 3.22; p = 0.5). CONCLUSIONS We observed a protective effect of statin therapy against the development of infections after cardiac operations, but not on mortality from these infections. Prospective investigations are needed to determine optimal dose and duration of statin therapy and their relationship to infectious complications.
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Affiliation(s)
- Matteo Trezzi
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA
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Greene MT, Chang R, Kuhn L, Rogers MAM, Chenoweth CE, Shuman E, Saint S. Predictors of hospital-acquired urinary tract-related bloodstream infection. Infect Control Hosp Epidemiol 2012; 33:1001-7. [PMID: 22961019 DOI: 10.1086/667731] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Bloodstream infection (BSI) secondary to nosocomial urinary tract infection is associated with substantial morbidity, mortality, and additional financial costs. Our objective was to identify predictors of nosocomial urinary tract-related BSI. DESIGN Matched case-control study. SETTING Midwestern tertiary care hospital. PATIENTS Cases (n=298) were patients with a positive urine culture obtained more than 48 hours after admission and a blood culture obtained within 14 days of the urine culture that grew the same organism. Controls (n=667), selected by incidence density sampling, included patients with a positive urine culture who were at risk for BSI but did not develop one. Methods. Conditional logistic regression and classification and regression tree analyses. RESULTS The most frequently isolated microorganisms that spread from the urinary tract to the bloodstream were Enterococcus species. Independent risk factors included neutropenia (odds ratio [OR], 10.99; 95% confidence interval [CI], 5.78-20.88), renal disease (OR, 2.96; 95% CI, 1.98-4.41), and male sex (OR, 2.18; 95% CI, 1.52-3.12). The probability of developing a urinary tract-related BSI among neutropenic patients was 70%. Receipt of immunosuppressants (OR, 1.53; 95% CI, 1.04-2.25), insulin (OR, 4.82; 95% CI, 2.52-9.21), and antibacterials (OR, 0.66; 95% CI, 0.44-0.97) also significantly altered risk. CONCLUSIONS The heightened risk of urinary tract-related BSI associated with several comorbid conditions suggests that the management of nosocomial bacteriuria may benefit from tailoring to certain patient subgroups. Consideration of time-dependent risk factors, such as medications, may also help guide clinical decisions in reducing BSI.
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Affiliation(s)
- M Todd Greene
- Division of General Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan 48109, USA.
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Calisto KL, Camacho AC, Mittestainer FC, Carvalho BM, Guadagnini D, Carvalheira JB, Saad MJ. Diacerhein attenuates the inflammatory response and improves survival in a model of severe sepsis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2012; 16:R158. [PMID: 22897821 PMCID: PMC3580748 DOI: 10.1186/cc11478] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 08/13/2012] [Indexed: 01/04/2023]
Abstract
Introduction Hyperglycemia and insulin resistance have been associated with a worse outcome in sepsis. Although tight glycemic control through insulin therapy has been shown to reduce morbidity and mortality rates, the effect of intensive insulin therapy in patients with severe sepsis is controversial because of the increased risk of serious adverse events related to hypoglycemia. Recently, knowledge about diacerhein, an anthraquinone drug with powerful antiinflammatory properties, revealed that this drug improves insulin sensitivity, mediated by the reversal of chronic subclinical inflammation. The aim of the present study was to evaluate whether the antiinflammatory effects of diacerhein after onset of sepsis-induced glycemic alterations is beneficial and whether the survival rate is prolonged in this situation. Methods Diffuse sepsis was induced by cecal ligation and puncture surgery (CLP) in male Wistar rats. Blood glucose and inflammatory cytokine levels were assessed 24 hours after CLP. The effect of diacerhein on survival of septic animals was investigated in parallel with insulin signaling and its modulators in liver, muscle, and adipose tissue. Results Here we demonstrated that diacerhein treatment improves survival during peritoneal-induced sepsis and inhibits sepsis-induced insulin resistance by improving insulin signaling via increased insulin-receptor substrate-1-associated phosphatidylinositol 3-kinase activity and Akt phosphorylation. Diacerhein also decreases the activation of endoplasmic reticulum stress signaling that involves upregulation of proinflammatory pathways, such as the I kappa B kinase and c-Jun NH2-terminal kinase, which blunts insulin-induced insulin signaling in liver, muscle, and adipose tissue. Additionally, our data show that this drug promoted downregulation of proinflammatory signaling cascades that culminate in transcription of immunomodulatory factors such interleukin (IL)-1β, IL-6, and tumor necrosis factor-α. Conclusions This study demonstrated that diacerhein treatment increases survival and attenuates the inflammatory response with a significant effect on insulin sensitivity. On the basis of efficacy and safety profile, diacerhein represents a novel antiinflammatory therapy for management of insulin resistance in sepsis and a potential approach for future clinical trials.
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Abstract
Sepsis is a common intensive care unit event occurring in approximately 750 000 patients annually, with a case mortality rate approaching 50%. Sepsis is characterized by a chaotic and excessive release of inflammatory cytokines and procoagulants including tumor necrosis factor, interleukin (IL)-1, IL-6, IL-8, platelet-activating factor, and tissue factor. Efforts to inhibit individual cytokines in order to modify poor outcomes have been generally disappointing, suggesting the need to target multiple inflammatory mediators to obtain clinical benefit. Statins lower lipids by inhibiting 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, which in turn inhibits the rate-limiting step in cholesterol biosynthesis. In addition to lowering total cholesterol, statins have pleiotropic effects on inflammation and immunity. Instead of impacting a single entity in the sepsis syndrome, statins may have positive effects on multiple inflammatory, immunomodulating, and coagulation targets involved in the development of infection and sepsis. There have been a number of institutional- and population-based studies that have evaluated the impact of statins in patients with infection and sepsis. Most of these studies, but not all, have demonstrated a number of positive outcomes in patients with statins, including reduction in mortality. Based on these data, statins are a promising therapy in the management of patients with sepsis and warrant larger and more rigorous clinical trials.
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Affiliation(s)
- Paul P Dobesh
- College of Pharmacy, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE 68198, USA.
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Kwok CS, Yeong JKY, Turner RM, Cavallazzi R, Singh S, Loke YK. Statins and associated risk of pneumonia: a systematic review and meta-analysis of observational studies. Eur J Clin Pharmacol 2011; 68:747-55. [DOI: 10.1007/s00228-011-1159-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 10/25/2011] [Indexed: 12/18/2022]
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Feeney JM, Jayaraman V, Spilka J, Shapiro DS, Ellner S, Marshall WT, Jacobs LM. Prehospital HMG Co-A reductase inhibitor use and reduced mortality in hemorrhagic shock due to trauma. Eur J Trauma Emerg Surg 2011; 38:171-6. [DOI: 10.1007/s00068-011-0144-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 07/11/2011] [Indexed: 12/12/2022]
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Yende S, Milbrandt EB, Kellum JA, Kong L, Delude RL, Weissfeld LA, Angus DC. Understanding the potential role of statins in pneumonia and sepsis. Crit Care Med 2011; 39:1871-8. [PMID: 21516038 PMCID: PMC3139804 DOI: 10.1097/ccm.0b013e31821b8290] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To examine the association of statin use with clinical outcomes and circulating biomarkers in community-acquired pneumonia and sepsis. DESIGN Multicenter inception cohort study. SETTING Emergency departments of 28 U.S. hospitals. PATIENTS A total of 1895 subjects hospitalized with community-acquired pneumonia. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Our approach consisted of two different comparison cohorts, each reflecting methods used in prior publications in this area. We first compared subjects with prior statin use (prior use cohort), defined as a history of statin use in the week before admission, with those with no prior use. We then compared prior statin users whose statins were continued inhospital (continued use cohort) with those with either no prior use or no inhospital use. We adjusted for patient characteristics, including demographics, comorbid conditions, and illness severity, and accounted for healthy user effect and indication bias using propensity analysis. We determined risk of severe sepsis and 90-day mortality. We measured markers inflammation (tumor necrosis factor, interleukin-6, interleukin-10), coagulation (antithrombin, factor IX, plasminogen activator inhibitor, d-dimer, thrombin antithrombin complex), and lymphocyte cell surface protein expression during the first week of hospitalization. There were no differences in severe sepsis risk between statin users and nonusers for prior (30.8% vs. 30.7%, p = .98) or continued statin use (30.2% vs. 30.8%, p = .85) in univariate analyses and after adjusting for patient characteristics and propensity for statin use. Ninety-day mortality was similar in prior statin users (9.2% vs. 12.0%, p = .11) and lower in continued statin users (7.9% vs. 12.1%, p = .02). After adjusting for patient characteristics and propensity for statin use, there was no mortality benefit for prior (odds ratio, 0.90 [0.63-1.29]; p = .57) or continued statin use (odds ratio, 0.73 [0.47-1.13]; p = .15). Only antithrombin activity over time was higher in statin subjects, yet the magnitude of the difference was modest. There were no differences in other coagulation, inflammatory, or lymphocyte cell surface markers. CONCLUSIONS We found no evidence of a protective effect for statin use on clinical outcomes and only modest differences in circulating biomarkers in community-acquired pneumonia, perhaps as a result of healthy user effects and indication bias.
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Affiliation(s)
- Sachin Yende
- CRISMA Laboratory (Clinical Research, Investigation, and Systems Modeling of Acute Illness), Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Kouroumichakis I, Papanas N, Proikaki S, Zarogoulidis P, Maltezos E. Statins in prevention and treatment of severe sepsis and septic shock. Eur J Intern Med 2011; 22:125-33. [PMID: 21402241 DOI: 10.1016/j.ejim.2010.12.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Revised: 10/28/2010] [Accepted: 12/07/2010] [Indexed: 12/13/2022]
Abstract
Severe sepsis is an infection-induced inflammatory syndrome that can lead to multi-organ dysfunction and continues to be a major cause of morbidity and mortality worldwide. Because numerous cascades are triggered during sepsis, selective blocking of inflammatory mediators may be insufficient to arrest this process, and recent therapeutic approaches have proven controversial. Statins are the most commonly prescribed agents for hypercholesterolaemia and dominate the area of cardiovascular risk reduction. Moreover, these drugs have a variety of actions that are independent of their lipid lowering effect. Such anti-inflammatory, antioxidant, immunomodulatory, and antiapoptotic features have been collectively referred to as pleiotropic effects. By virtue of their pleiotropic effects, statins have also emerged as potentially useful in various critical care areas such as bacteraemia, the early phases of sepsis and septic shock, as well as the management of serious infections. This review outlines current evidence on the use of statins for preventing and treating sepsis.
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Affiliation(s)
- I Kouroumichakis
- Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
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Kruger PS, Harward ML, Jones MA, Joyce CJ, Kostner KM, Roberts MS, Venkatesh B. Continuation of Statin Therapy in Patients with Presumed Infection. Am J Respir Crit Care Med 2011; 183:774-81. [DOI: 10.1164/rccm.201006-0955oc] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Calisto KL, Carvalho BDM, Ropelle ER, Mittestainer FC, Camacho ACA, Guadagnini D, Carvalheira JBC, Saad MJA. Atorvastatin improves survival in septic rats: effect on tissue inflammatory pathway and on insulin signaling. PLoS One 2010; 5:e14232. [PMID: 21151908 PMCID: PMC2997789 DOI: 10.1371/journal.pone.0014232] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2010] [Accepted: 11/13/2010] [Indexed: 12/14/2022] Open
Abstract
The aim of the present study was to investigate whether the survival-improving effect of atorvastatin in sepsis is accompanied by a reduction in tissue activation of inflammatory pathways and, in parallel, an improvement in tissue insulin signaling in rats. Diffuse sepsis was induced by cecal ligation and puncture surgery (CLP) in male Wistar rats. Serum glucose and inflammatory cytokines levels were assessed 24 h after CLP. The effect of atorvastatin on survival of septic animals was investigated in parallel with insulin signaling and its modulators in liver, muscle and adipose tissue. Atorvastatin improves survival in septic rats and this improvement is accompanied by a marked improvement in insulin sensitivity, characterized by an increase in glucose disappearance rate during the insulin tolerance test. Sepsis induced an increase in the expression/activation of TLR4 and its downstream signaling JNK and IKK/NF-κB activation, and blunted insulin-induced insulin signaling in liver, muscle and adipose tissue; atorvastatin reversed all these alterations in parallel with a decrease in circulating levels of TNF-α and IL-6. In summary, this study demonstrates that atorvastatin treatment increased survival, with a significant effect upon insulin sensitivity, improving insulin signaling in peripheral tissues of rats during peritoneal-induced sepsis. The effect of atorvastatin on the suppression of the TLR-dependent inflammatory pathway may play a central role in regulation of insulin signaling and survival in sepsis insult.
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Affiliation(s)
- Kelly Lima Calisto
- Department of Internal Medicine, FCM, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Bruno de Melo Carvalho
- Department of Internal Medicine, FCM, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Eduardo Rochete Ropelle
- Department of Internal Medicine, FCM, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | | | | | - Dioze Guadagnini
- Department of Internal Medicine, FCM, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | | | - Mario José Abdalla Saad
- Department of Internal Medicine, FCM, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
- * E-mail:
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Medeiros CACX, Leitão RFC, Macedo RN, Barboza DRMM, Gomes AS, Nogueira NAP, Alencar NMN, Ribeiro RA, Brito GAC. Effect of atorvastatin on 5-fluorouracil-induced experimental oral mucositis. Cancer Chemother Pharmacol 2010; 67:1085-100. [PMID: 20661736 DOI: 10.1007/s00280-010-1409-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2010] [Accepted: 07/11/2010] [Indexed: 12/21/2022]
Abstract
PURPOSE Oral mucositis (OM) is a frequent side effect in patients with cancer. We investigate the effect of atorvastatin (ATV), a cholesterol-lowering drug, on OM induced by 5-fluorouracil (5-FU) in hamsters. METHODS OM was induced by the i.p. administration of 5-FU, with excoriations of the cheek pouch mucosa. The animals were pretreated with i.p. ATV 1, 5 or 10 mg/kg or vehicle (saline and 5% (vol/vol) ethanol) 30 min before 5-FU injection and daily for 5 or 10 days. Samples of cheek pouches and main organs were removed for histopathological analysis, determination of TNF-α, IL-1β, nitrite, non-protein sulfhydryl group (NP-SH) levels, myeloperoxidase (MPO) assay and immunohistochemistry for induced nitric oxide synthase (iNOS). Blood was collected for a leukogram analysis of biochemical parameters and analysis of bacteremia. RESULTS ATV at doses of 1 and 5 mg/kg reduced mucosal damage and inflammation, as well as the levels of cytokines, nitrite and myeloperoxidase activity on the 5th and 10th day of OM and immunostaining for iNOS on the 5th day of OM.ATV at 1 mg/kg increased cheek pouch NP-SH when compared to 5-FU groups on the 10th day of OM. The association between ATV 5 mg/kg and 5-FU decreased the survival rate, amplified the leukopenia of animals, increased transaminase serum levels and caused liver lesions. We also detected the presence of Gram-negative bacillus in the blood of 100% of the animals treated with ATV 5 mg/kg + 5-FU. CONCLUSIONS Atorvastatin prevented mucosal damage and inflammation associated with 5-FU-induced OM, but the association of a higher dose of ATV with 5-FU induced hepatotoxicity and amplified leukopenia.
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Affiliation(s)
- C A C X Medeiros
- Department of Biomedical Sciences, State University of Rio Grande do Norte, Mossoró, Brazil
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Rao AD, Milbrandt EB. To JUPITER and beyond: statins, inflammation, and primary prevention. Crit Care 2010; 14:310. [PMID: 20497597 PMCID: PMC2911709 DOI: 10.1186/cc9006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ajay D Rao
- Clinical Fellow, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Eric B Milbrandt
- Assistant Professor, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Thillemann TM, Pedersen AB, Mehnert F, Johnsen SP, Søballe K. The risk of revision after primary total hip arthroplasty among statin users: a nationwide population-based nested case-control study. J Bone Joint Surg Am 2010; 92:1063-72. [PMID: 20439650 DOI: 10.2106/jbjs.h.01805] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Statins have been associated with beneficial effects on bone metabolism and inflammation in both experimental and clinical studies. The association between statin use and the risk of revision after primary total hip arthroplasty has not been examined. METHODS We identified 2349 patients from the Danish Hip Arthroplasty Registry who underwent revision of a primary total hip replacement in the period from 1996 to 2005 and matched them, using propensity score matching, with 2349 controls with a total hip replacement who had not had a revision. Using conditional logistic regression, we estimated the relative risk of revision due to all causes and due to specific causes according to postoperative statin use. RESULTS The ten-year cumulative implant revision rate in the underlying cohort of 57,581 total hip arthroplasties from the registry was 8.9% (95% confidence interval, 8.4% to 9.4%). Postoperative statin use was associated with an adjusted relative risk of revision of 0.34 (95% confidence interval, 0.28 to 0.41) compared with no use of statin. Statin use was associated with a reduced risk of revision due to deep infection, aseptic loosening, dislocation, and periprosthetic fracture. No difference in the risk of revision due to pain or implant failure was found between statin users and nonusers. CONCLUSIONS The use of statins was associated with a substantially lower revision risk following primary total hip arthroplasty. Statins, however, should not be prescribed to healthy patients undergoing total hip arthroplasty in order to improve the longevity of the replacement until further studies have confirmed our finding and the mechanisms for this association have been clarified.
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Affiliation(s)
- Theis M Thillemann
- Department of Orthopedics, Aarhus University Hospital, Aarhus N, Denmark.
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Abstract
Since the introduction of HMG-CoA reductase inhibitors (statins) for lowering lipids, a large amount of data has been published demonstrating their potential benefits in conditions as varied as cancer, osteoporosis, and Alzheimer's dementia. We reviewed the published literature on MEDLINE from articles between 1950 and 2008 on the non-atheroprotective effects of statins and noted consistent benefits of statin use in improving outcomes of ventricular arrhythmias, sudden cardiac death, cardiac transplant rejection, chronic obstructive pulmonary disease, and sepsis. However, for these conditions, the level of evidence was inadequate to recommend statin use. The evidence for improving outcomes in atrial fibrillation, mortality in heart failure, contrast-induced nephropathy, cataract, age-related macular degeneration, sub-arachnoid hemorrhage, osteoporosis, dementia, and cancer incidence was conflicting and inconclusive. Furthermore, we found that most of the literature consists of small observational studies and their conclusions are often not corroborated by results from larger or randomized studies. Pending large, well designed, randomized trials, we conclude that there is no definite evidence for the use of statins in any condition besides hyperlipidemia and atherosclerosis.
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Affiliation(s)
- Abhimanyu Beri
- Department of Internal Medicine, Michigan State University, East Lansing, Michigan, USA.
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An assessment of the effect of statin use on the incidence of acute respiratory infections in England during winters 1998-1999 to 2005-2006. Epidemiol Infect 2010; 138:1281-8. [PMID: 20109259 DOI: 10.1017/s0950268810000105] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Statins reduce cardiovascular mortality and related risks associated with pneumonia suggesting potentially beneficial use in influenza pandemics. We investigated the effect of current statin use on acute respiratory infections in primary care. Data from anonymized electronic medical records of persons aged 45 years were examined for statin use, chronic morbidity, respiratory diagnoses, vaccination procedures, and immune suppression. Logistic regression models were used to calculate odds ratios (ORs) for statin users vs. non-users in respiratory infection outcomes. A total of 329 881 person-year observations included 18% statin users and 46% influenza vaccinees. Adjusted ORs for statin users vs. non-users were: influenza-like illness, 1.05 (95% CI 0.92-1.20); acute bronchitis, 1.08 (95% CI 1.01-1.15); pneumonia, 0.91 (95% CI 0.73-1.13); all acute respiratory infections, 1.03 (95% CI 0.98-1.07); and urinary tract infections, 0.91 (95% CI 0.85-0.98). We found no benefit in respiratory infection outcomes attributable to statin use, although uniformly higher ORs in non-vaccinated statin users might suggest synergism between statins and influenza vaccination.
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Dobesh PP, Klepser DG, McGuire TR, Morgan CW, Olsen KM. Reduction in mortality associated with statin therapy in patients with severe sepsis. Pharmacotherapy 2009; 29:621-30. [PMID: 19476415 DOI: 10.1592/phco.29.6.621] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVE To evaluate the effect of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) on mortality in patients with severe sepsis. DESIGN Retrospective cohort study. SETTING Intensive care unit (ICU) of an academic medical center. PATIENTS One hundred eighty-eight patients aged 40 years or older with a diagnosis of severe sepsis and an ICU stay between January 1, 2005, and December 31, 2006. MEASUREMENTS AND MAIN RESULTS Patient demographic data, statin use, and Acute Physiology and Chronic Health Evaluation (APACHE) II scores at the time of sepsis diagnosis were collected from the patient database. We used a multivariable logistic regression model to evaluate the association between statin use and in-hospital all-cause mortality after controlling for age, sex, and severity of illness. Of the 188 patients who met our inclusion criteria, 60 (32%) had statin exposure. Patients receiving statins were similar in age, sex, and APACHE II scores to those not receiving statins. In the univariable comparison, the statin group had a 35% relative reduction in mortality compared with the nonstatin group (mortality rate 31.7% vs 48.4%, p=0.040). Most of the mortality reduction attributed to statins occurred in patients with APACHE II scores higher than 24 (mortality rate 32.3% vs 57.5%, p=0.031), with a minimal mortality difference in patients with APACHE II scores of 24 or lower (31% vs 36.4%, p=0.810). In the multivariable regression model, statin use had a protective effect (odds ratio [OR] 0.42, 95% confidence interval [CI] 0.21-0.84, p=0.014), whereas increasing age (OR 1.03, 95% CI 1.01-1.06, p=0.013) and higher APACHE II score (OR 1.11, 95% CI 1.05-1.18, p=0.001) were associated with increased mortality. CONCLUSION The use of statins was associated with a protective effect in patients with severe sepsis, as demonstrated by a significant reduction in mortality compared with patients not receiving statins.
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Affiliation(s)
- Paul P Dobesh
- College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska 68198-6045, USA.
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Feeney JM, Burns K, Staff I, Bai J, Rodrigues N, Fortier J, Jacobs LM. Prehospital HMG Co-A Reductase Inhibitor Use and Reduced Mortality in Ruptured Abdominal Aortic Aneurysm. J Am Coll Surg 2009; 209:41-6. [DOI: 10.1016/j.jamcollsurg.2009.03.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Revised: 03/03/2009] [Accepted: 03/04/2009] [Indexed: 11/29/2022]
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Dublin S, Jackson ML, Nelson JC, Weiss NS, Larson EB, Jackson LA. Statin use and risk of community acquired pneumonia in older people: population based case-control study. BMJ 2009; 338:b2137. [PMID: 19531550 PMCID: PMC2697311 DOI: 10.1136/bmj.b2137] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To test the hypothesis that hydroxymethyl glutaryl coenzyme A reductase inhibitors (statins) may decrease the risk of community acquired pneumonia. DESIGN Population based case-control study. SETTING Group Health, a large integrated healthcare delivery system. Population Immunocompetent, community dwelling Group Health members aged 65 to 94; two matched controls for each case with pneumonia. Information on comorbid illnesses and functional and cognitive status, potential confounders of the association between statin use and risk of pneumonia, came from medical record review and computerised pharmacy data. MAIN OUTCOME MEASURE Adjusted estimates of risk of pneumonia in relation to current statin use. RESULTS 1125 validated cases of pneumonia and 2235 matched controls were identified. Compared with controls, cases were more likely to have chronic lung and heart disease, especially severe disease, and functional or cognitive impairment. Current statin use was present in 16.1% (181/1125) of cases and 14.6% (327/2235) of controls (adjusted odds ratio 1.26, 95% confidence interval 1.01 to 1.56). Among cases admitted to hospital and matched controls, current statin use was present in 17.2% (68/395) of cases and 14.2% (112/788) of controls (adjusted odds ratio 1.61, 1.08 to 2.39, compared with non-use). In people in whom statins were indicated for secondary prevention, the adjusted odds ratio for risk of pneumonia in relation to current statin use was 1.25 (0.94 to 1.67); in those with no such indication, it was 0.81 (0.46 to 1.42). CONCLUSIONS Statin use was not associated with decreased risk of pneumonia among immunocompetent, community dwelling older people. Findings of previous studies may reflect "healthy user" bias.
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Affiliation(s)
- Sascha Dublin
- Group Health Center for Health Studies, 1730 Minor Avenue, Suite 1600, Seattle WA 98101-1448, USA.
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Novack V, Eisinger M, Frenkel A, Terblanche M, Adhikari NKJ, Douvdevani A, Amichay D, Almog Y. The effects of statin therapy on inflammatory cytokines in patients with bacterial infections: a randomized double-blind placebo controlled clinical trial. Intensive Care Med 2009; 35:1255-60. [PMID: 19205663 DOI: 10.1007/s00134-009-1429-0] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Accepted: 01/24/2009] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine if statin therapy reduces the incidence of severe sepsis and the levels of inflammatory cytokines in patients with acute bacterial infection. DESIGN Double-blind placebo controlled randomized clinical trial. SETTING Department of medicine and medical intensive care unit in a tertiary university medical center. PATIENTS AND PARTICIPANTS A total of 83 patients with suspected or documented bacterial infection were enrolled. We randomly assigned 42 patients to receive 40 mg of simvastatin orally, followed by 20 mg of simvastatin, and 41 to receive matching placebo. MEASUREMENTS AND RESULTS The study was prematurely terminated due to slow recruitment rate. Here we report the analysis of the secondary outcome: change in cytokines levels at 72 h. Both groups were evenly matched in terms of co-morbidity and severity of illness on admission. Four of the 83 patients enrolled developed severe sepsis, two in each group. No difference was observed in other clinical variables and there were no mortalities. Cytokine levels were randomly assessed in 40 patients (20 in each group). Both TNF-alpha and IL-6 levels were significantly reduced in the simvastatin group (p = 0.02 and p = 0.02, respectively), while no such difference was observed in the placebo group (p = 0.35 and 0.39, respectively). CONCLUSIONS Statin therapy may be associated with a reduction in the levels of inflammatory cytokines in patients with acute bacterial infections. Large controlled trials will determine if this reduction will translate into a clinical benefit.
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Affiliation(s)
- Victor Novack
- Department of Medicine, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev, Beersheba, Israel
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Kor DJ, Iscimen R, Yilmaz M, Brown MJ, Brown DR, Gajic O. Statin administration did not influence the progression of lung injury or associated organ failures in a cohort of patients with acute lung injury. Intensive Care Med 2009; 35:1039-46. [PMID: 19183945 DOI: 10.1007/s00134-009-1421-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Accepted: 12/10/2008] [Indexed: 11/29/2022]
Abstract
PURPOSE Preclinical studies suggest that HMG-CoA reductase inhibitors (statins) may attenuate organ dysfunction. We evaluated whether statins are associated with attenuation of lung injury and prevention of associated organ failure in patients with ALI/ARDS. METHODS From a database of patients with ALI/ARDS, we determined the presence and timing of statin administration. Main outcome measures were the development and progression of pulmonary and nonpulmonary organ failures as assessed by changes in PaO(2)/FiO(2) ratio and Sequential Organ Failure Assessment score (SOFA) between days 1 and 7 after the onset of ALI/ARDS. Secondary outcomes included ventilator free days, ICU and hospital mortality, and lengths of ICU and hospital stay. RESULTS From 178 patients with ALI/ARDS, 45 (25%) received statin therapy. From day 1 to day 7, the statin group showed less improvement in their PaO(2)/FiO(2) ratio (27 vs. 55, P = 0.042). Ventilator free days (median 21 vs. 16 days, P = 0.158), development or progression of organ failures (median DeltaSOFA 1 vs. 2, P = 0.275), ICU mortality (20% vs. 23%, P = 0.643), and hospital mortality (27 vs. 37%, P = 0.207) were not significantly different in the statin and non-statin groups. After adjustment for baseline characteristics and propensity for statin administration, there were no differences in ICU or hospital lengths of stay. CONCLUSION In this retrospective cohort study, statin use was not associated with improved outcome in patients with ALI/ARDS. We were unable to find evidence for protection against pulmonary or nonpulmonary organ dysfunction.
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Affiliation(s)
- Daryl J Kor
- Division of Critical Care Medicine, Department of Anesthesiology, Multidisciplinary Epidemiology and Translational Research in Intensive Care, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
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Gao F, Linhartova L, Johnston AM, Thickett DR. Statins and sepsis. Br J Anaesth 2008; 100:288-98. [PMID: 18276651 DOI: 10.1093/bja/aem406] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Severe sepsis and septic shock is common and frequently fatal. Over the last few years, the primary treatments demonstrated to improve outcome from several major clinical trials have finally emerged. However, translating these recent therapeutic advances to routine clinical practice has proven controversial, and new approaches of additional strategies are continued to be developed. Given their pleiotropic effects related to many pathophysiological determinants of sepsis, statin therapy could be the next step in the search for adjuvant therapy. A future challenge may be to test both the efficacy and the safety by large randomized controlled clinical trials ascertaining the effects of statins administered at the onset of sepsis and in patients with severe sepsis or septic shock admitted into intensive care units.
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Affiliation(s)
- F Gao
- Academic Department of Anaesthesia, Critical Care, and Pain, Heart of England NHS Foundation Trust, University of Warwick, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, UK.
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Mortensen EM, Restrepo MI, Copeland LA, Pugh JA, Anzueto A, Cornell JE, Pugh MJV. Impact of previous statin and angiotensin II receptor blocker use on mortality in patients hospitalized with sepsis. Pharmacotherapy 2008; 27:1619-26. [PMID: 18041882 DOI: 10.1592/phco.27.12.1619] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
STUDY OBJECTIVE To examine the effect of previous outpatient use of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) and/or angiotensin II receptor blockers (ARBs) on 30-day mortality in patients hospitalized with sepsis. DESIGN Retrospective national cohort study. DATA SOURCE Department of Veterans Affairs (VA) national patient care and pharmacy databases. PATIENTS A total of 3018 patients who were hospitalized with sepsis in fiscal year 2000, had at least 1 year of previous VA outpatient care, and had at least one active and filled VA prescription within 90 days of admission. MEASUREMENTS AND MAIN RESULTS The primary outcome was 30-day mortality. The primary analysis was a multilevel model with hospital as a random effect and control variables that included comorbid conditions, demographics, and other drugs. Among the 3018 patients hospitalized with sepsis, mean age was 74.4 years, 2975 (98.6%) were male, and 811 (26.9%) died within 30 days of admission. Regarding prescription drug use, 480 patients (15.9%) were taking statins and 107 (3.5%) were taking ARBs. After adjusting for potential confounders, statin use (odds ratio [OR] 0.48, 95% confidence interval [CI] 0.36-0.64) and ARB use (OR 0.42, 95% CI 0.24-0.76) were significantly associated with decreased 30-day mortality. CONCLUSIONS Use of statins and/or ARBs before admission was associated with decreased mortality in patients hospitalized with sepsis. Further research is needed to determine if these drugs might be started on admission for those with sepsis.
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Affiliation(s)
- Eric M Mortensen
- VERDICT Research Center, South Texas Veterans Health Care System, San Antonio, Texas 78284, USA.
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Montaner J, Chacón P, Krupinski J, Rubio F, Millán M, Molina CA, Hereu P, Quintana M, Alvarez-Sabín J. Simvastatin in the acute phase of ischemic stroke: a safety and efficacy pilot trial. Eur J Neurol 2007; 15:82-90. [PMID: 18070096 DOI: 10.1111/j.1468-1331.2007.02015.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Although statins are being used for secondary prevention of ischemic stroke, recent experimental data have shown new pleiotropic effects of these drugs responsible for their role in neuroprotection. We conducted a pilot, double-blind, randomized, multicenter clinical trial to study for the first time safety and efficacy of simvastatin in the acute phase of ischemic stroke. Simvastatin/placebo was given at 3-12 h from symptom onset to 60 patients with cortical strokes. Efficacy on the evolution of several inflammation markers [interleukin (IL)-6, IL-8, IL-10, monocyte chemoattractant protein-1, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, C-reactive protein, sApo/Fas, tumor necrosis factor-alpha, E-selectin, L-selectin and nitrites+nitrates] and neurological outcome was evaluated at baseline, day 1, 3, 5, 7 and 90. No differences were found amongst the biomarkers studied regarding treatment allocation. Although simvastatin patients improved significantly by the third day (46.4% vs. 17.9%, P = 0.022), a non-significant increase in mortality and greater proportion of infections (odds ratio 2.4, confidence interval 1.06-5.4) in the simvastatin group were the main safety concerns. Therefore, a larger clinical trial is needed to confirm the net benefit of this therapeutic approach.
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Affiliation(s)
- J Montaner
- Neurovascular Research Laboratory, Neurovascular Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
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Levin AI, Coetzee AR. Statins and perioperative myocardial infarction. Mechanisms of action. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2007. [DOI: 10.1080/22201173.2007.10872496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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