Preoperative Statin Administration Does Not Protect Against Early Postoperative Acute Respiratory Distress Syndrome

Abstract

Background Statins have been shown to possess anti-inflammatory and immunomodulatory effects. The objective of this study was to determine if preoperative statin therapy is associated with a reduced frequency of postoperative ARDS in surgical populations at increased risk of developing ARDS. Methods We performed a retrospective cohort evaluation of the association between preoperative statin therapy and early postoperative ARDS in patients undergoing elective high-risk thoracic and aortic vascular surgery. The association between preoperative statin therapy and postoperative ARDS was assessed using propensity-adjusted analyses to control for indication bias and confounding factors. Results Of 1845 patients, 722 were receiving preoperative statin therapy. 120 patients developed postoperative ARDS. Frequencies of ARDS among those receiving statin therapy versus those who were not was 7.2% and 6.1%, respectively (OR = 1.20, 95% CI = 0.83–1.75; p=0.330). Neither the stratified propensity score analysis (pooled OR 0.93; 95% CI = 0.60-1.43) nor matched analysis (OR = 0.78; 95% CI = 0.48-1.27) identified a statistically significant association between preoperative statin administration and postoperative ARDS. When compared to matched controls, patients who developed postoperative ARDS did not differ in mortality (7.7% versus 8.8%, p=0.51), hospital length of stay (21 days versus 15 days, p=0.21) or ventilator free days (24 days versus 25 days, p=0.62). Conclusions In patients undergoing high-risk surgery, preoperative statin therapy was not associated with a statistically significant reduction in postoperative ARDS. These results do not support the use of statins as prophylaxis against ARDS in patients undergoing high-risk surgery.

Statins for the prevention and treatment of acute lung injury and acute respiratory distress syndrome: A systematic review and meta‐analysis

“…But it should be interpreted with caution, because of the significant heterogeneity in included studies. Our finding was consistent with the conclusions of the only RCT and a recent study by Yadav et al . However, a previous study, covering 575 ICU patients, indicates that the prevalence of ALI/ARDS is lower in patients receiving prior statin therapy than in non‐statin group.…”

“…Major characteristics of the included studies are summarized in Table . In general, the 13 studies, including four RCTs and nine cohort studies, were published between 2007 and 2015 covering a total of 12 145 patients.…”

Association of Perioperative Statin Use With Mortality and Morbidity After Major Noncardiac Surgery

“…Effects of statins on respiratory or infectious complications in medical patients are controversial, with limited data in the perioperative setting. Le Manach et al30 reported no difference in postoperative pneumonia in a vascular cohort, and Yadav et al33 reported no difference in rates of early postoperative adult respiratory dis-…”

Clinical Strategies to Prevent Acute Respiratory Distress Syndrome

“…66 Although animal and preliminary human studies had also suggested statins may have a preventive role in ARDS, a randomized controlled trial of 540 patients and other observational studies have been disappointing. [67][68][69] Other proposed potential therapies for ARDS prevention include angiotensin inhibitors, curcumin, 70 peroxisome proliferator receptor antagonist, 71,72 and adrenomodulin. 73…”