Statins do not improve short-term survival in an oriental population with sepsis

Yang, Kai-Chien; Chien, Jung-Yien; Tseng, Wei‐Kung; Hsueh, Po-Ren; Yu, Chong‐Jen; Wu, Chau‐Chung

doi:10.1016/j.ajem.2006.09.011

Cited by 45 publications

(61 citation statements)

References 23 publications

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“…Furthermore, several clinical studies performed to determine the effects of statins on patients with sepsis revealed a decrease in the risk of infection-related mortality [7] and a prevention of severity of sepsis [8] . Nevertheless, another study did not show any effect of survival of sepsis in oriental people [9] .…”

Section: Introductionmentioning

confidence: 99%

Effects of HMG-CoA Reductase Inhibition by Simvastatin on Vascular Dysfunction Induced by Lipopolysaccharide in Rats

et al. 2008

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Aims: Statins have been identified as a potentially interesting treatment against sepsis. Here, we study the vascular reactivity of aortae from rats treated with lipopolysaccharide (LPS), 4 mg · kg^–1, following chronic administration of simvastatin (SV) 10 mg · kg^–1. Methods: The rats were treated with either vehicle or SV for 4 weeks before administration of LPS. After 18 h, the systolic blood pressure (SBP) was measured using a tail cuff and vascular and endothelial responses of aortic rings to several agonists were studied in an organ bath. Results: LPS injection decreased the SBP by 38 mm Hg and vascular response to phenylephrine (Phe) by 60%. Plasma nitrates and nitrites (NO_x) were 3-fold higher after LPS. This attenuated response to Phe was prevented by incubation with either the inducible-nitric-oxide-synthase (iNOS)-selective inhibitor 1400W or the endothelial nitric oxide synthase (eNOS)/iNOS nonselective blocker L-NAME. The presence of endothelium did not alter these findings. Administering LPS to SV-treated rats also decreased the SBP and increased the NO_x concentration. The impaired response to Phe was restored by blocking NO synthesis in endothelium-denuded but not in intact aortic rings. The response to acetylcholine demonstrated an enhanced reduction in arteries from the SV + LPS group compared with the LPS group. The inhibition of iNOS prevented acetylcholine-induced relaxation in rings from LPS-treated rats but not in those from the SV + LPS group. Conclusion: These results suggest that statins may reduce iNOS-mediated NO production in endothelial but not in vascular smooth-muscle cells.

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Section: Introductionmentioning

confidence: 99%

Effects of HMG-CoA Reductase Inhibition by Simvastatin on Vascular Dysfunction Induced by Lipopolysaccharide in Rats

et al. 2008

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“…However, there was some controversy about the effects of pre-existing statin use on clinical outcomes of septic shock patients. Indeed, two studies have shown that stain use was associated with decreased 30-day mortality or infection-related mortality in septic shock patients [23,24], while the other two studies showed no beneficial effects of statin use on survival of septic shock [25,26]. In the remaining one, stain use was associated with poor prognosis and increased hospital mortality in septic shock patients [27].…”

Section: Discussionmentioning

confidence: 99%

“…As far as we know, there were five retrospective, nonmatched cohort studies to examine the effect of preexisting statin use on mortality of septic shock patients [23][24][25][26][27]. However, there was some controversy about the effects of pre-existing statin use on clinical outcomes of septic shock patients.…”

Section: Discussionmentioning

confidence: 99%

Statins and hemoperfusion improve 28-day survival in septic shock patients

et al. 2012

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AbstractUncontrolled inflammation and endotoxin play a central role in septic shock. Statins may possess anti-inflammatory properties, and removal of endotoxin by hemoperfusion with polymyxin B-immobilized fiber (PMX-F) could have favorable effects on sepsis. We examined retrospectively whether pre-existing statin and hemoperfusion with PMX-F at the time of admission were separately and independently associated with decreased overall 28-day mortality in septic shock patients. Consecutive 173 patients with septic shock (71.2±10.7 years old, 115 male and 58 female) were included in the present study. All patients underwent a complete history and physical examination, determination of blood chemistries. Multiple stepwise regression analysis revealed that albumin, creatinine (inversely), statin use, hemoperfusion with PMX-F and HDL-cholesterol were independently correlated to 28-day survival in septic shock patients (R2=0.464). Our present study suggests that pre-existing statin use and hemoperfusion with PMX-F may separately and independently contribute to blunt the process of septic shock.

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“…Cohort studies have also suggested a long-term mortality bene�t (180 to 365 days) in general ICU patients [38] and patients with pneumonia [39] exposed to statins. On the other hand, there are observational cohort studies that did not �nd an association between statin exposure and early mortality in patients with these in�ammatory conditions [39][40][41][42]. A meta-analysis of cohort trials suggested a treatment bene�t with statins (relative risk of death 0.55, 95% con�dence interval 0.36-0.83) but also noted signi�cant heterogeneity ( .…”

Section: Discussionmentioning

confidence: 99%

Continuation or Discontinuation of Statin Therapy Did Not Influence Patient Outcomes after the Development of Acute Respiratory Distress Syndrome

2013

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Background. The anti-inflammatory effects of statin therapy may be beneficial in the treatment and prevention of acute respiratory distress syndrome (ARDS). Objectives. Determine if continuation or discontinuation of prior statin therapy is associated with ventilator-free days (VFDs) at day 28 in patients with ARDS. Methods. Patients with ARDS admitted to the intensive care units of a tertiary care medical center were evaluated in this retrospective cohort study. Included patients were allocated to three groups: patients in whom statin therapy was given before and continued after ARDS diagnosis (Group 1), patients with statin therapy only before ARDS diagnosis (Group 2), and patients never exposed to statins (Group 3). Results. Of 244 patients evaluated, 187 were included; 17 (9.1%) patients in Group 1, 20 (10.7%) in Group 2, and 150 in Group 3. There were no differences among groups in APACHE II or SOFA scores. VFDs were not significantly different among groups (median 0 versus 4.5 versus 13.5 days, P=0.21). After adjustment for baseline characteristics, including propensity for statin administration, statin therapy was not associated with increased VFDs on linear regression. Conclusions. Exposure to statins before or after ARDS diagnosis was not associated with improved VFDs in this cohort of patients with ARDS.

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Statins do not improve short-term survival in an oriental population with sepsis

Cited by 45 publications

References 23 publications

Effects of HMG-CoA Reductase Inhibition by Simvastatin on Vascular Dysfunction Induced by Lipopolysaccharide in Rats

Effects of HMG-CoA Reductase Inhibition by Simvastatin on Vascular Dysfunction Induced by Lipopolysaccharide in Rats

Statins and hemoperfusion improve 28-day survival in septic shock patients

Continuation or Discontinuation of Statin Therapy Did Not Influence Patient Outcomes after the Development of Acute Respiratory Distress Syndrome

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