Statins and outcomes in patients with bloodstream infection

Abstract

Background The pleiotropic effects of statins, 3-hydroxy-3 methylglutaryl coenzyme A reductase inhibitor, have been shown to modify inflammatory cell signaling on the immune response to infection. It was postulated that statins may be a good candidate as novel therapeutic agents for the treatment of sepsis. Objective We investigated whether ongoing statin therapy is associated with mortality in patients with bloodstream infection. Design A retrospective cohort study Setting Two tertiary hospitals in Bronx, New York Patients Adult patients in the hospital with bloodstream infection and categorized according to statin therapy as an outpatient or inpatient prior to bacteremia. Intervention None. Measurement and Main Results Of 2139 bacteremic hospitalized patients, 592 (28%) received statins prior to blood cultures and 677 (32%) died within 90-days. On multivariate adjustment, the association between statin therapy and 90-day all-cause mortality was statistically significant (HR 0.78; 95% C.I. 0.65 – 0.94) but statin users and non-users differed significantly on many baseline clinical factors. Using the propensity score matched analysis to balance the differences between groups, the association was no longer significant (HR 0.99, 95% CI 0.77 – 1.25). Multivariate analysis after stratifying by decile in propensity score for statin use demonstrated similar results (HR 0.86; 95% CI 0.70 – 1.06). Statin use was not associated with reduced ICU admission (OR 0.86; 95% CI 0.59 – 1.26), hospital LOS (β = −0.8 days, 95% CI −2.2 – 1.7 days), ICU LOS (β = −0.1 days, 95% CI −3.7 – 3.8 days), or need for mechanical or non-invasive ventilation (OR 1.03; 95% CI 0.70 – 1.51). Conclusion After adjusting for the propensity to receive statin therapy, no statistically significant association between statin therapy prior to bloodstream infection and survival was identified.

Prior statin use and 90-day mortality in Gram-negative and Gram-positive bloodstream infection: a prospective observational study

“…In the total cohort of BSI, the unadjusted OR for mortality among statin users compared with non-users did not differ much from what has been found by other investigators [7, 9, 11]. In one study, adjustment for possible confounding factors attenuated the effect measure to a value above 1 [11].…”

Evidence To Support Continuation of Statin Therapy in Patients with Staphylococcus aureus Bacteremia

“…This statin exposure definition combined both prevalent (of unknown timing and duration) and incident statin users, as well as patients continuing and not continuing statin therapy. Not surprisingly, statin use in this study was not associated with reductions in 90-day mortality, intensive care unit (ICU) admission, or hospital/ICU discharge when adjusting for confounders, including indications for statin therapy, using propensity score methods (17).…”

“…Indeed, some studies have included patients with such varied statin exposures, and application of the study findings to clinical practice would not be possible. One observational study defined statin use as the presence of a statin on the day of culture regardless of previous or continued use (17). This statin exposure definition combined both prevalent (of unknown timing and duration) and incident statin users, as well as patients continuing and not continuing statin therapy.…”

Do statins prevent acute kidney injury?

“…A number of observational studies have shown an apparent decrease in mortality from sepsis associated with the use of statins [72][73][74] but the results are again far from conclusive [75,76]. In a metaanalysis of studies, any benefit from statins observed in retrospective cohorts of patients disappeared when propensity matching and concurrent risk factors were considered [77].…”