A Population-Based Cohort Study on the Drug-Specific Effect of Statins on Sepsis Outcome
Journal
Chest
Journal Volume
153
Journal Issue
4
Pages
805-815
Date Issued
2018
Author(s)
Abstract
Background: Whether statin treatment, proved by recent experimental studies to have an antimicrobial activity, exerts a drug- or a class-specific effect in sepsis remains unknown. Methods: Short-term mortality in patients with sepsis was analyzed using data from the National Health Insurance Research Database. Use of statins was defined as the cumulative use of a specific statin (atorvastatin, simvastatin, or rosuvastatin) for > 30 days prior to the index sepsis admission. We determined the association between statin and sepsis outcome by multivariate-adjusted Cox models and propensity score (PS)-matched analysis, using a 1:1:1 PS matching technique. Results: A total of 52,737 patients with sepsis fulfilled the inclusion criteria, of which 1,855 were prescribed atorvastatin, 916 were prescribed simvastatin, and 732 were prescribed rosuvastatin. Compared with nonusers, simvastatin (hazard ratio [HR], 0.72; 95% CI, 0.58-0.90) and atorvastatin (HR, 0.78; 95% CI, 0.68-0.90) were associated with an improved 30-day survival, whereas rosuvastatin was not (HR, 0.87; 95% CI, 0.73-1.04). Using rosuvastatin as the reference, atorvastatin (HR, 0.79; 95% CI, 0.64-0.99) and simvastatin (HR, 0.77; 95% CI, 0.59-0.99) had superior effectiveness in preventing mortality. Conclusions: Compatible with in vitro experimental findings, our results suggest that the drug-specific effect of statins on sepsis is not correlated to their lipid-lowering potency. ? 2017 American College of Chest Physicians
SDGs
Other Subjects
acetylsalicylic acid; atorvastatin; biological product; corticosteroid; disease modifying antirheumatic drug; hydroxymethylglutaryl coenzyme A reductase inhibitor; immunosuppressive agent; nonsteroid antiinflammatory agent; rosuvastatin; simvastatin; antiinfective agent; antilipemic agent; atorvastatin; hydroxymethylglutaryl coenzyme A reductase inhibitor; rosuvastatin; simvastatin; aged; Article; clinical outcome; cohort analysis; controlled study; drug effect; drug efficacy; drug use; female; hospital admission; human; longitudinal study; major clinical study; male; mortality; outcome assessment; population research; prescription; priority journal; sepsis; survival time; clinical trial; comparative study; epidemiology; multicenter study; respiratory failure; sepsis; Taiwan; treatment outcome; Aged; Anti-Infective Agents; Atorvastatin; Cohort Studies; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypolipidemic Agents; Male; Respiratory Insufficiency; Rosuvastatin Calcium; Sepsis; Simvastatin; Taiwan; Treatment Outcome
Type
journal article