Impact of prior statin therapy on the outcome of patients with suspected ventilator-associated pneumonia: an observational studyReport as inadecuate




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Critical Care

, 18:R83

First Online: 28 April 2014Received: 11 October 2013Accepted: 09 April 2014

Abstract

IntroductionVentilator-associated pneumonia VAP is the most commonly acquired infection in intensive care units ICU. Its outcome is related, at least in part, to the host’s response. Statins have anti-inflammatory effects and may thus improve the outcome. We aimed to assess the impact of prior statin use in the setting of VAP.

MethodsA six-year cohort study was conducted in a French ICU at a teaching hospital. All of the patients with suspected VAP were included. Baseline characteristics, outcomes, statin exposure, and the description of suspected episodes were collected prospectively. The primary endpoint was 30-day mortality. Patients who were taking statins before admission to the ICU whether or not treatment was continued thereafter ‘previous users’ group were compared to those without prior statin therapy ‘statin-naive’ group. A survival analysis using a Cox model was conducted in the whole cohort and in the subgroup of prior statin users.

ResultsAmong the 349 patients included, 93 26.6% had taken statins. At baseline, these patients were at higher risk of complications than statin-naive ones for example, older, more likely to be men and to have underlying diseases, greater simplified acute physiology score II SAPS II. There was, however, no difference regarding severity at the time VAP was suspected sequential organ failure assessment SOFA: 9.0 4.0 to 16.0 versus 8.0 4.0 to 17.0; P = 0.11. Nonetheless, 30-day mortality in statin users was not different from that in statin-naive patients 35.5% versus 26.2%, respectively; adjusted hazard ratio HR = 1.23 0.79 to 1.90 95% confidence interval CI; P = 0.36. In contrast, after limiting analysis to prior statin users and adjusting for potential confounders, those who continued the treatment had better survival than those who did not HR = 0.47; 0.22 to 0.97 95% CI; P = 0.04.

ConclusionsStatin continuation in prior users could provide protective effects in patients with suspected VAP.

AbbreviationsCFUcolony-forming unit

CIconfidence interval

CPISclinical pulmonary infection score

HRhazard ratio

ICUintensive care unit

MDRmultidrug resistant

MVmechanical ventilation

PCTprocalcitonin

RCTrandomized controlled trial

SAPS IIsimplified acute physiology score II

SOFAsequential organ failure assessment

VAPventilator-associated pneumonia

VILIventilator-induced lung injury.

Electronic supplementary materialThe online version of this article doi:10.1186-cc13845 contains supplementary material, which is available to authorized users.

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Author: Rémi Bruyere - Clara Vigneron - Sébastien Prin - André Pechinot - Jean-Pierre Quenot - Serge Aho - Laurent Papazian - Pi

Source: https://link.springer.com/







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