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... »

PAGES

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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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37 French intensive care units
38 MethodsA
39 ResultsAmong
40 VAP
41 admission
42 analysis
43 anti-inflammatory effects
44 baseline
45 baseline characteristics
46 better survival
47 care unit
48 characteristics
49 cohort
50 cohort study
51 complications
52 confounders
53 continuation
54 contrast
55 description
56 differences
57 effect
58 endpoint
59 episodes
60 exposure
61 high risk
62 hospital
63 host response
64 impact
65 infection
66 intensive care unit
67 model
68 mortality
69 observational study
70 one
71 outcomes
72 outcomes of patients
73 part
74 patients
75 pneumonia
76 potential confounders
77 primary endpoint
78 prior statin therapy
79 prior statin use
80 prior statin users
81 prior users
82 protective effect
83 response
84 risk
85 setting
86 severity
87 six-year cohort study
88 statin exposure
89 statin therapy
90 statin use
91 statin users
92 statin-naive patients
93 statins
94 study
95 subgroups
96 survival
97 survival analysis
98 teaching hospital
99 therapy
100 treatment
101 units
102 use
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