Statin therapy is associated with reduced incidence of hypoxic hepatitis in critically ill patients

Drolz, Andreas; Horvatits, Thomas; Michl, Barbara; Roedl, Kevin; Schellongowski, Peter; Holzinger, Ulrike; Zauner, Christian; Gisslinger, Heinz; Madl, Christian; Trauner, Michael; Fuhrmann, Valentin

doi:10.1016/j.jhep.2014.01.019

Cited by 32 publications

(23 citation statements)

References 53 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Statins reduce IL-6 mediated C-reactive protein 27 , an acute phase reactant, produced mostly in the hepatocytes and marker of poor prognosis in cirrhosis 28 . Pre-clinical data suggest that simvastatin may attenuate liver inflammation and liver injury associated with infections or bleeding 29 and data in humans show that statins are protective in ischemic hepatitis 30 . Statin use has also been shown to suppress hepatitis C activity in-vitro and in-vivo 31, 32 , with recent data suggesting that the concomitant use of statins while undergoing antiviral treatment increases the likelihood of sustained virologic response 33 .…”

Section: Discussionmentioning

confidence: 99%

Statins Are Associated With a Decreased Risk of Decompensation and Death in Veterans With Hepatitis C–Related Compensated Cirrhosis

2016

View full text Add to dashboard Cite

Background & Aims Statins decrease portal pressure in patients with cirrhosis and increase survival times of those who have bled from varices. However, statins can be hepatotoxic. It is important to determine whether long-term statin use will be beneficial or detrimental for patients with cirrhosis because physicians are reluctant to prescribe statins to patients with liver disease. We investigated effects of statins on decompensation and survival times in patients with compensated cirrhosis. Methods We performed a retrospective cohort using the Veteran Affairs Clinical Case Registry, which contains nationwide data from veterans infected with the hepatitis C virus (HCV). We identified patients with compensated cirrhosis from January 1996 through December 2009. Statin use was according to filled prescriptions. Cirrhosis and decompensation were determined from ICD9 codes, using a validated algorithm. Results Among 40,512 patients with HCV compensated cirrhosis (98% male, median age of 56 years), 2802 statin users were identified. We developed a propensity score model using variables associated with statin prescription, and new statin users were matched with up to 5 non-users; 685 statin users were matched with 2062 non-users. Discrimination of the propensity score model was 0.92. Statin users had lower risk of decompensation (hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.39–0.77)] and death (HR, 0.56; 95% CI, 0.46–0.69), compared with non-users. Findings persisted after adjustment for age, FIB-4 index score, serum level of albumin, model for end-stage liver disease and Child scores (HR for decompensation, 0.55; 95% CI, 0.39–0.78) and HR for death, 0.55; 95% CI, 0.45–0.68). Conclusions Based on data from the Veteran Affairs Clinical Case Registry, statin use among patients with HCV and compensated cirrhosis is associated with over 40% lower risk of cirrhosis decompensation and death. Although statins cannot yet be widely recommended for these patients, their use should not be avoided.

show abstract

Section: Discussionmentioning

confidence: 99%

Statins Are Associated With a Decreased Risk of Decompensation and Death in Veterans With Hepatitis C–Related Compensated Cirrhosis

2016

View full text Add to dashboard Cite

show abstract

“…(34)(35)(36) If papers met inclusion criteria but were found to be a duplicate analysis of the same cohort, the study with the largest cohort was included. (3,22,37,38) The range of peak liver enzyme (aspartate aminotransferase (AST) or alanine aminotransferase (ALT)) cutoffs varied between studies. We accepted any cutoff of at least 300 IU/L (excluding 2 studies that included low peak values which have been reviewed previously and another that defined ischemic hepatitis using ICD-9 codes) (35,36,39).…”

Section: Methodsmentioning

confidence: 99%

“…Chavez-Tapia reported an unadjusted (and therefore likely misleading) positive association between death and vasopressor use. (42) Drolz and colleagues presented the only risk-adjusted positive treatment effect when they described the salutary effect of prehospital statin therapy on the odds of developing IH in a prospective ICU cohort study (58% reduction), potentially by reducing the risk of ischemia-reperfusion injury (38). …”

mentioning

confidence: 99%

The Incidence and Outcomes of Ischemic Hepatitis: A Systematic Review with Meta-analysis

Tapper

Sengupta

Bonder

2015

The American Journal of Medicine

130

120

View full text Add to dashboard Cite

“…In experimental studies, statins (inhibitors of 3‐hydroxy‐3‐methylglutaryl‐conenzyme A reductase) improved hepatic microcirculation and endothelial function, dampened the inflammatory response, and reduced ischemia/reperfusion injuries . Accordingly, pretreatment with statins was associated with reduced rates of HLI in a prospective cohort study of critically ill patients . Spontaneous hypoglycemia is associated with excessive high mortality rates in HLI and should be treated immediately .…”

Section: Hypoxic Liver Injurymentioning

confidence: 99%

Liver Injury and Failure in Critical Illness

et al. 2019

Self Cite

View full text Add to dashboard Cite

The frequency of acquired liver injury and failure in critical illness has been significantly increasing over recent decades. Currently, liver injury and failure are observed in up to 20% of patients in intensive care units and are associated with significantly increased morbidity and mortality. Secondary forms of liver injury in critical illness are divided primarily into cholestatic, hypoxic, or mixed forms. Therefore, sufficient knowledge of underlying alterations (e.g., hemodynamic, inflammatory, or drug induced) is key to a better understanding of clinical manifestations, prognostic implications, as well as diagnostic and therapeutic options of acquired liver injury and failure. This review provides a structured approach for the evaluation and treatment of acquired liver injury and failure in critically ill patients.

show abstract

Statin therapy is associated with reduced incidence of hypoxic hepatitis in critically ill patients

Cited by 32 publications

References 53 publications

Statins Are Associated With a Decreased Risk of Decompensation and Death in Veterans With Hepatitis C–Related Compensated Cirrhosis

Statins Are Associated With a Decreased Risk of Decompensation and Death in Veterans With Hepatitis C–Related Compensated Cirrhosis

The Incidence and Outcomes of Ischemic Hepatitis: A Systematic Review with Meta-analysis

Liver Injury and Failure in Critical Illness

Contact Info

Product

Resources

About