The association between prior statin use and long-term outcomes after critical care admission

Beed, Martin; Brindley, Peter G.; Mahajan, Ravi; Juttner, I.; Campion-Smith, Jo; Wilson, V.G.

doi:10.1016/j.jcrc.2016.04.031

Cited by 4 publications

(1 citation statement)

References 42 publications

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“…23 However, Beed et al reported that there was no association between previous statin use and survival outcome after ICU admission. 24 These studies did not consider the effects of different types of statins 25 or the daily dose. 15 Copyright © 2019, the American Society of Anesthesiologists, Inc.…”

Section: Discussionmentioning

confidence: 99%

Preadmission Statin Use and 90-day Mortality in the Critically Ill

Song

Lee

et al. 2019

Anesthesiology

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Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background This study aimed to examine the association between preadmission statin use and 90-day mortality in critically ill patients and to investigate whether this association differed according to statin type and dose. We hypothesized that preadmission statin use was associated with lower 90-day mortality. Methods This retrospective cohort study analyzed the medical records of all adult patients admitted to the intensive care unit in a single tertiary academic hospital between January 2012 and December 2017. Data including preadmission statin use, statin subtype, and daily dosage were collected, and the associations between these variables and 90-day mortality after intensive care unit admission were examined. The primary endpoint was 90-day mortality. Results A total of 24,928 patients (7,396 statin users and 17,532 non–statin users) were included. After propensity score matching, 5,354 statin users and 7,758 non–statin users were finally included. The 90-day mortality rate was significantly higher in non–statin users (918 of 7,758; 11.8%) than in statin users (455 of 5,354; 8.5%; P < 0.001). In Cox regression analysis, the 90-day mortality rate was lower among statin users than among non–statin users (hazard ratio: 0.70, 95% CI: 0.63 to 0.79; P < 0.001). Rosuvastatin use was associated with 42% lower 90-day mortality (hazard ratio: 0.58, 95% CI: 0.47 to 0.72; P < 0.001). There were no specific significant differences in the association between daily statin dose and 90-day mortality. In competing risk analysis, the risk of noncardiovascular 90-day mortality in statin users was 32% lower than that in non–statin users (hazard ratio: 0.68, 95% CI: 0.60 to 0.78; P < 0.001). Meanwhile, cardiovascular 90-day mortality was not significantly associated with statin use. Conclusions Preadmission statin use was associated with a lower 90-day mortality. This association was more evident in the rosuvastatin group and with noncardiovascular 90-day mortality; no differences were seen according to daily dosage intensity.

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Section: Discussionmentioning

confidence: 99%

Preadmission Statin Use and 90-day Mortality in the Critically Ill

Song

Lee

et al. 2019

Anesthesiology

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Pharmacological management of sepsis in adults with a focus on the current gold standard treatments and promising adjunctive strategies: evidence from the last five years

Kyriazopoulou

Giamarellos‐Bourboulis

2019

Expert Opinion on Pharmacotherapy

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Survival benefit of a low ratio of visceral to subcutaneous adipose tissue depends on LDL clearance versus production in sepsis

Lee¹,

Genga²,

Pisitsak³

et al. 2018

Crit Care

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BackgroundPatients with sepsis with a high ratio of visceral adipose tissue (VAT) to subcutaneous adipose tissue (SAT) have increased mortality. Our goal was to investigate the mechanism of this effect, noting that low LDL levels are also associated with increased sepsis mortality. Accordingly we tested for association between VAT/SAT, low-density lipoprotein (LDL) levels, and mortality. Then we examined the effect of statin treatment, which decreases LDL production, and the effect of PCSK9 genotype, which increases LDL clearance.MethodsWe performed retrospective analysis of a cohort of patients with sepsis from a tertiary care adult intensive care unit in Vancouver, Canada, who underwent abdominal computed tomography (CT) (n = 75) for clinical reasons. We compared LDL levels in patients with sepsis according to high versus low VAT/SAT and 90-day survival. We next examined the effects of statin therapy and PCSK9 loss-of-function genotype on survival.ResultsPatients with a low VAT/SAT had increased 90-day survival and were relatively protected against low LDL levels in sepsis compared to high VAT/SAT. Statin treatment abrogated the beneficial effects of low VAT/SAT; eliminating the difference in LDL levels and survival between patients with low and high VAT/SAT. PSCK9 loss-of-function genotype similarly eliminated the increased LDL levels in low VAT/SAT patients but, in contrast, increased the survival advantage of low VAT/SAT compared to high VAT/SAT.ConclusionsLow LDL levels per se are not simply associated with decreased sepsis survival because lowering LDL levels by inhibiting LDL production (statin treatment) is associated with adverse outcomes, while increased LDL clearance (PCSK9 loss-of-function genotype) is associated with improved outcomes in patients with low VAT/SAT.Electronic supplementary materialThe online version of this article (10.1186/s13054-018-1985-1) contains supplementary material, which is available to authorized users.

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The association between prior statin use and long-term outcomes after critical care admission

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Cited by 4 publications

References 42 publications

Preadmission Statin Use and 90-day Mortality in the Critically Ill

Preadmission Statin Use and 90-day Mortality in the Critically Ill

Pharmacological management of sepsis in adults with a focus on the current gold standard treatments and promising adjunctive strategies: evidence from the last five years

Survival benefit of a low ratio of visceral to subcutaneous adipose tissue depends on LDL clearance versus production in sepsis

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