Lipid profile and statin use in critical care setting: implications for kidney outcome

Abstract

Objective: To determine whether pre-hospital statin use is associated with lower renal replacement therapy requirement and/or death during intensive care unit stay. Methods: Prospective cohort analysis. We analyzed 670 patients consecutively admitted to the intensive care unit of an academic tertiary-care hospital. Patients with ages ranging from 18 to 80 years admitted to the intensive care unit within the last 48 hours were included in the study. Results: Mean age was 66±16.1 years old, mean body mass index 26.6±4/9kg/m 2 and mean abdominal circumference was of 97±22cm. The statin group comprised 18.2% of patients and had lower renal replacement therapy requirement and/or mortality (OR: 0.41; 95%CI: 0.18-0.93; p=0.03). The statin group also had lower risk of developing sepsis during intensive care unit stay (OR: 0.42; 95%CI: 0.22-0.77; p=0.006) and had a reduction in hospital length-of-stay (14.7±17.5 days versus 22.3±48 days; p=0.006). Statin therapy was associated with a protective role in critical care setting independently of confounding variables, such as gender, age, C-reactive protein, need of mechanical ventilation, use of pressor agents and presence of diabetes and/or coronary disease. Conclusion: Statin therapy prior to hospital admission was associated with lower mortality, lower renal replacement therapy requirement and sepsis rates.

Effects of statins on the incidence and outcomes of acute kidney injury in critically ill patients: a systematic review and meta-analysis

“…It was suggested that HDL and LDL particles could represent important regulators of human response to endotoxemia, as well as that serum triglycerides frequently increase in systemic inflammatory reactions [64][65][66][67]. Thus, in critically ill patients statins might improve AKI through their so-called pleiotropic (LDL-cholesterol independent) effects with direct tissue-protective effects on the renal vasculature and tubular cells, and a systemic anti-inflammatory effect [41,48,[68][69][70].…”

“…Consistently, an observational study in patients undergoing major vascular surgery demonstrated improved long-term survival (OR = 0.60) in statin users, who were also shown much better complete kidney function recovery in case it was deteriorated [ 35 ]. In a prospective cohort study of patients consecutively admitted to the ICU, a significantly lower requirement for renal replacement therapy (RRT) and mortality was found (OR = 0.41) among approximately one fifth of patients who were taking statins prior to hospital admission [ 53 ]. Similarly, in patients treated for community-acquired pneumonia, although statins did not diminish the AKI development, their use was associated with a lower long-term follow-up risk of death [ 57 ].…”

Baseline serum triglyceride predicts early-onset peritonitis and prognosis in incident CAPD patients

“…[ 23 ] In contrast, a recent study demonstrated that lipid-lowering therapy prior to hospital admission may improve clinical outcomes and be associated with shorter hospital stays, lower renal replacement therapy requirements and mortality in critically ill patients. [ 24 ] However, the role of TGs in the pathogenesis of cardiovascular disease mortality and the role of lipid-modifying medications in dialysis patients remain uncertain. In patients with hemodialysis, there have been limited studies investigating the association between serum TG levels and all-cause and cardiovascular mortality.…”