Statins and outcomes in patients with bloodstream infection

A propensity-matched analysis

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Objective: The pleiotropic effects of statins, 3-hydroxy-3 methylglutaryl coenzyme A reductase inhibitor, have been shown to modify inflammatory cell signaling on the immune response to infection. It was postulated that statins may be a good candidate as novel therapeutic agents for the treatment of sepsis. We investigated whether ongoing statin therapy is associated with mortality in patients with bloodstream infection. Design: A retrospective cohort study. Setting: Two tertiary hospitals in Bronx, NY. PATIENTS:: Adult patients in the hospital with bloodstream infection and categorized according to statin therapy as an outpatient or inpatient before bacteremia. Interventions: None. MEASUREMENT AND MAIN RESULTS:: Of 2,139 bacteremic hospitalized patients, 592 (28%) received statins before blood cultures and 677 (32%) died within 90 days. On multivariate adjustment, the association between statin therapy and 90-day all-cause mortality was statistically significant (hazard ratio, 0.78; 95% confidence interval [CI] 0.65-0.94), but statin users and nonusers differed significantly on many baseline clinical factors. Using the propensity score matched analysis to balance the differences between groups, the association was no longer significant (hazard ratio 0.99; 95% CI 0.77-1.25). Multivariate analysis after stratifying by decile in propensity score for statin use demonstrated similar results (hazard ratio 0.86; 95% CI 0.70-1.06). Statin use was not associated with reduced intensive care unit admission (odds ratio [OR], 0.86; 95% CI 0.59-1.26), hospital length of stay (β =-0.8 days; 95% CI-2.2 to 1.7 days), intensive care unit length of stay (β =-0.1 days; 95% CI-3.7 to 3.8 days), or need for mechanical or noninvasive ventilation (OR 1.03; 95% CI 0.70-1.51). Conclusion: After adjusting for the propensity to receive statin therapy, no statistically significant association between statin therapy before bloodstream infection and survival was identified.

Original languageEnglish (US)
Pages (from-to)1064-1071
Number of pages8
JournalCritical Care Medicine
Volume40
Issue number4
DOIs
StatePublished - Apr 2012

Fingerprint

Hydroxymethylglutaryl-CoA Reductase Inhibitors
Infection
Confidence Intervals
Length of Stay
Propensity Score
Therapeutics
Intensive Care Units
Odds Ratio
Noninvasive Ventilation
Mortality
Bacteremia
Artificial Respiration
Tertiary Care Centers
Inpatients
Sepsis
Oxidoreductases
Cohort Studies
Outpatients
Multivariate Analysis
Retrospective Studies

Keywords

  • bacteremia
  • cohort study
  • mortality
  • propensity score analysis
  • sepsis
  • statins

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Statins and outcomes in patients with bloodstream infection : A propensity-matched analysis. / Leung, Sharon S.; Pokharel, Reha; Gong, Michelle Ng.

In: Critical Care Medicine, Vol. 40, No. 4, 04.2012, p. 1064-1071.

Research output: Contribution to journalArticle

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title = "Statins and outcomes in patients with bloodstream infection: A propensity-matched analysis",
abstract = "Objective: The pleiotropic effects of statins, 3-hydroxy-3 methylglutaryl coenzyme A reductase inhibitor, have been shown to modify inflammatory cell signaling on the immune response to infection. It was postulated that statins may be a good candidate as novel therapeutic agents for the treatment of sepsis. We investigated whether ongoing statin therapy is associated with mortality in patients with bloodstream infection. Design: A retrospective cohort study. Setting: Two tertiary hospitals in Bronx, NY. PATIENTS:: Adult patients in the hospital with bloodstream infection and categorized according to statin therapy as an outpatient or inpatient before bacteremia. Interventions: None. MEASUREMENT AND MAIN RESULTS:: Of 2,139 bacteremic hospitalized patients, 592 (28{\%}) received statins before blood cultures and 677 (32{\%}) died within 90 days. On multivariate adjustment, the association between statin therapy and 90-day all-cause mortality was statistically significant (hazard ratio, 0.78; 95{\%} confidence interval [CI] 0.65-0.94), but statin users and nonusers differed significantly on many baseline clinical factors. Using the propensity score matched analysis to balance the differences between groups, the association was no longer significant (hazard ratio 0.99; 95{\%} CI 0.77-1.25). Multivariate analysis after stratifying by decile in propensity score for statin use demonstrated similar results (hazard ratio 0.86; 95{\%} CI 0.70-1.06). Statin use was not associated with reduced intensive care unit admission (odds ratio [OR], 0.86; 95{\%} CI 0.59-1.26), hospital length of stay (β =-0.8 days; 95{\%} CI-2.2 to 1.7 days), intensive care unit length of stay (β =-0.1 days; 95{\%} CI-3.7 to 3.8 days), or need for mechanical or noninvasive ventilation (OR 1.03; 95{\%} CI 0.70-1.51). Conclusion: After adjusting for the propensity to receive statin therapy, no statistically significant association between statin therapy before bloodstream infection and survival was identified.",
keywords = "bacteremia, cohort study, mortality, propensity score analysis, sepsis, statins",
author = "Leung, {Sharon S.} and Reha Pokharel and Gong, {Michelle Ng}",
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T1 - Statins and outcomes in patients with bloodstream infection

T2 - A propensity-matched analysis

AU - Leung, Sharon S.

AU - Pokharel, Reha

AU - Gong, Michelle Ng

PY - 2012/4

Y1 - 2012/4

N2 - Objective: The pleiotropic effects of statins, 3-hydroxy-3 methylglutaryl coenzyme A reductase inhibitor, have been shown to modify inflammatory cell signaling on the immune response to infection. It was postulated that statins may be a good candidate as novel therapeutic agents for the treatment of sepsis. We investigated whether ongoing statin therapy is associated with mortality in patients with bloodstream infection. Design: A retrospective cohort study. Setting: Two tertiary hospitals in Bronx, NY. PATIENTS:: Adult patients in the hospital with bloodstream infection and categorized according to statin therapy as an outpatient or inpatient before bacteremia. Interventions: None. MEASUREMENT AND MAIN RESULTS:: Of 2,139 bacteremic hospitalized patients, 592 (28%) received statins before blood cultures and 677 (32%) died within 90 days. On multivariate adjustment, the association between statin therapy and 90-day all-cause mortality was statistically significant (hazard ratio, 0.78; 95% confidence interval [CI] 0.65-0.94), but statin users and nonusers differed significantly on many baseline clinical factors. Using the propensity score matched analysis to balance the differences between groups, the association was no longer significant (hazard ratio 0.99; 95% CI 0.77-1.25). Multivariate analysis after stratifying by decile in propensity score for statin use demonstrated similar results (hazard ratio 0.86; 95% CI 0.70-1.06). Statin use was not associated with reduced intensive care unit admission (odds ratio [OR], 0.86; 95% CI 0.59-1.26), hospital length of stay (β =-0.8 days; 95% CI-2.2 to 1.7 days), intensive care unit length of stay (β =-0.1 days; 95% CI-3.7 to 3.8 days), or need for mechanical or noninvasive ventilation (OR 1.03; 95% CI 0.70-1.51). Conclusion: After adjusting for the propensity to receive statin therapy, no statistically significant association between statin therapy before bloodstream infection and survival was identified.

AB - Objective: The pleiotropic effects of statins, 3-hydroxy-3 methylglutaryl coenzyme A reductase inhibitor, have been shown to modify inflammatory cell signaling on the immune response to infection. It was postulated that statins may be a good candidate as novel therapeutic agents for the treatment of sepsis. We investigated whether ongoing statin therapy is associated with mortality in patients with bloodstream infection. Design: A retrospective cohort study. Setting: Two tertiary hospitals in Bronx, NY. PATIENTS:: Adult patients in the hospital with bloodstream infection and categorized according to statin therapy as an outpatient or inpatient before bacteremia. Interventions: None. MEASUREMENT AND MAIN RESULTS:: Of 2,139 bacteremic hospitalized patients, 592 (28%) received statins before blood cultures and 677 (32%) died within 90 days. On multivariate adjustment, the association between statin therapy and 90-day all-cause mortality was statistically significant (hazard ratio, 0.78; 95% confidence interval [CI] 0.65-0.94), but statin users and nonusers differed significantly on many baseline clinical factors. Using the propensity score matched analysis to balance the differences between groups, the association was no longer significant (hazard ratio 0.99; 95% CI 0.77-1.25). Multivariate analysis after stratifying by decile in propensity score for statin use demonstrated similar results (hazard ratio 0.86; 95% CI 0.70-1.06). Statin use was not associated with reduced intensive care unit admission (odds ratio [OR], 0.86; 95% CI 0.59-1.26), hospital length of stay (β =-0.8 days; 95% CI-2.2 to 1.7 days), intensive care unit length of stay (β =-0.1 days; 95% CI-3.7 to 3.8 days), or need for mechanical or noninvasive ventilation (OR 1.03; 95% CI 0.70-1.51). Conclusion: After adjusting for the propensity to receive statin therapy, no statistically significant association between statin therapy before bloodstream infection and survival was identified.

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