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Objectives To determine if prehospital statin use is associated with a lower risk of sepsis, ALI/ARDS, and mortality in critically ill patients. We also investigated the effect of combined prehospital use of both statins and aspirin. Design Cross-sectional analysis of a prospective cohort Patients 575 critically ill patients admitted to the medical or surgical ICU of an academic tertiary-care hospital Measurements and Main Results Of 575 patients, 149 (26%) were on statin therapy prior to hospitalization. A multivariable analysis including age, gender, current tobacco use, prehospital aspirin use, race, and APACHE II score revealed that patients on statin therapy prior to hospitalization were less likely to have or develop severe sepsis (OR 0.62, 95% CI 0.40 to 0.96) or ALI/ARDS (OR 0.60, 95% CI 0.36 to 0.99) during the first four ICU days. In-hospital mortality for patients with and without prehospital statin use (OR 1.06, 95% CI 0.62 to 1.83) was similar. Patients who had prehospital use of both statins and aspirin had the lowest rates of severe sepsis, ALI/ARDS and mortality. Conclusions Prehospital use of statins may be protective against the sepsis and ALI. This effect may be potentiated by prehospital aspirin use.

Objectives Platelet activation plays an active role in the pathogenesis of acute respiratory distress syndrome (ARDS). In our prior study of 575 patients at high risk for ARDS, concurrent statin and aspirin use was associated with reduced ARDS. However, the largest study (n=3855) to date found no significant benefit of prehospital aspirin in a lower risk population when adjusted for the propensity for aspirin use. We aimed to determine whether prehospital aspirin use is associated with decreased ARDS in patients at high risk for ARDS after adjusting for the propensity to receive aspirin. Design Secondary analysis of patients enrolled prospectively in the Validating Acute Lung Injury Markers for Diagnosis (VALID) study. Patients A total of 1149 critically ill patients (age ≥ 40) admitted to the medical or surgical intensive care units of an academic tertiary care hospital including 575 previously reported patients as well as additional patients who were enrolled after completion of the prior statin and aspirin study. Intervention None Measurements and Results Of 1149 patients, 368 (32%) developed ARDS during the first four ICU days and 287 (25%) patients had prehospital aspirin use. Patients with prehospital aspirin had significantly lower incidence of ARDS (27% vs. 34%, p=0.034). In a multivariable, propensity-adjusted analysis including age, gender, race, sepsis and APACHE II, prehospital aspirin use was associated with a decreased risk of ARDS (OR 0.66, 95% CI 0.46-0.94) in the entire cohort and in a subgroup of 725 patients with sepsis (OR 0.60, 95% CI 0.41-0.90). Conclusions In this selected cohort of critically ill patients, prehospital aspirin use was independently associated with a decreased risk of ARDS even after adjusting for the propensity of pre-hospital aspirin use. These findings support the need for prospective clinical trials to determine whether aspirin may be beneficial for the prevention of clinical ARDS.