Impact of prior statin therapy on the outcome of patients with suspected ventilator-associated pneumonia: an observational study View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2014-04-28

AUTHORS

Rémi Bruyere, Clara Vigneron, Sébastien Prin, André Pechinot, Jean-Pierre Quenot, Serge Aho, Laurent Papazian, Pierre-Emmanuel Charles

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. More... »

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DOI

http://dx.doi.org/10.1186/cc13845

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1029347177

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/24774941


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    "description": "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\u2019s 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 (\u2018previous users\u2019 group) were compared to those without prior statin therapy (\u2018statin-naive\u2019 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\u2009=\u20090.11). 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)\u2009=\u20091.23 (0.79 to 1.90) 95% confidence interval (CI); P\u2009=\u20090.36). 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\u2009=\u20090.47; (0.22 to 0.97) 95% CI; P\u2009=\u20090.04).ConclusionsStatin continuation in prior users could provide protective effects in patients with suspected VAP.", 
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29 schema:description 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.
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36 French intensive care units
37 MethodsA
38 ResultsAmong
39 VAP
40 admission
41 analysis
42 anti-inflammatory effects
43 baseline
44 baseline characteristics
45 better survival
46 care unit
47 characteristics
48 cohort
49 cohort study
50 complications
51 confounders
52 continuation
53 contrast
54 description
55 differences
56 effect
57 endpoint
58 episodes
59 exposure
60 high risk
61 hospital
62 host response
63 impact
64 infection
65 intensive care unit
66 model
67 mortality
68 observational study
69 one
70 outcomes
71 outcomes of patients
72 part
73 patients
74 pneumonia
75 potential confounders
76 primary endpoint
77 prior statin therapy
78 prior statin use
79 prior statin users
80 prior users
81 protective effect
82 response
83 risk
84 setting
85 severity
86 six-year cohort study
87 statin exposure
88 statin therapy
89 statin use
90 statin users
91 statin-naive patients
92 statins
93 study
94 subgroups
95 survival
96 survival analysis
97 teaching hospital
98 therapy
99 treatment
100 units
101 use
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