A Population-Based Cohort Study on the Drug-Specific Effect of Statins on Sepsis Outcome

Chien Chang Lee, Meng tse Gabriel Lee, Tzu Chun Hsu, Lorenzo Porta, Shy Shin Chang, Chia Hung Yo, Kuang Chau Tsai, Matthew Lee

Research output: Contribution to journalArticle

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Abstract

Background: Whether statin treatment, proved by recent experimental studies to have an antimicrobial activity, exerts a drug- or a class-specific effect in sepsis remains unknown. Methods: Short-term mortality in patients with sepsis was analyzed using data from the National Health Insurance Research Database. Use of statins was defined as the cumulative use of a specific statin (atorvastatin, simvastatin, or rosuvastatin) for > 30 days prior to the index sepsis admission. We determined the association between statin and sepsis outcome by multivariate-adjusted Cox models and propensity score (PS)-matched analysis, using a 1:1:1 PS matching technique. Results: A total of 52,737 patients with sepsis fulfilled the inclusion criteria, of which 1,855 were prescribed atorvastatin, 916 were prescribed simvastatin, and 732 were prescribed rosuvastatin. Compared with nonusers, simvastatin (hazard ratio [HR], 0.72; 95% CI, 0.58-0.90) and atorvastatin (HR, 0.78; 95% CI, 0.68-0.90) were associated with an improved 30-day survival, whereas rosuvastatin was not (HR, 0.87; 95% CI, 0.73-1.04). Using rosuvastatin as the reference, atorvastatin (HR, 0.79; 95% CI, 0.64-0.99) and simvastatin (HR, 0.77; 95% CI, 0.59-0.99) had superior effectiveness in preventing mortality. Conclusions: Compatible with in vitro experimental findings, our results suggest that the drug-specific effect of statins on sepsis is not correlated to their lipid-lowering potency.

Original languageEnglish
Pages (from-to)805-815
Number of pages11
JournalChest
Volume153
Issue number4
DOIs
Publication statusPublished - Apr 1 2018

Fingerprint

Hydroxymethylglutaryl-CoA Reductase Inhibitors
Sepsis
Cohort Studies
Simvastatin
Pharmaceutical Preparations
Population
Propensity Score
Mortality
National Health Programs
Proportional Hazards Models
Databases
Lipids
Survival
Atorvastatin Calcium
Rosuvastatin Calcium
Research

Keywords

  • atorvastatin
  • rosuvastatin
  • sepsis
  • simvastatin
  • statin

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Lee, C. C., Lee, M. T. G., Hsu, T. C., Porta, L., Chang, S. S., Yo, C. H., ... Lee, M. (2018). A Population-Based Cohort Study on the Drug-Specific Effect of Statins on Sepsis Outcome. Chest, 153(4), 805-815. https://doi.org/10.1016/j.chest.2017.09.024

A Population-Based Cohort Study on the Drug-Specific Effect of Statins on Sepsis Outcome. / Lee, Chien Chang; Lee, Meng tse Gabriel; Hsu, Tzu Chun; Porta, Lorenzo; Chang, Shy Shin; Yo, Chia Hung; Tsai, Kuang Chau; Lee, Matthew.

In: Chest, Vol. 153, No. 4, 01.04.2018, p. 805-815.

Research output: Contribution to journalArticle

Lee, CC, Lee, MTG, Hsu, TC, Porta, L, Chang, SS, Yo, CH, Tsai, KC & Lee, M 2018, 'A Population-Based Cohort Study on the Drug-Specific Effect of Statins on Sepsis Outcome', Chest, vol. 153, no. 4, pp. 805-815. https://doi.org/10.1016/j.chest.2017.09.024
Lee, Chien Chang ; Lee, Meng tse Gabriel ; Hsu, Tzu Chun ; Porta, Lorenzo ; Chang, Shy Shin ; Yo, Chia Hung ; Tsai, Kuang Chau ; Lee, Matthew. / A Population-Based Cohort Study on the Drug-Specific Effect of Statins on Sepsis Outcome. In: Chest. 2018 ; Vol. 153, No. 4. pp. 805-815.
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abstract = "Background: Whether statin treatment, proved by recent experimental studies to have an antimicrobial activity, exerts a drug- or a class-specific effect in sepsis remains unknown. Methods: Short-term mortality in patients with sepsis was analyzed using data from the National Health Insurance Research Database. Use of statins was defined as the cumulative use of a specific statin (atorvastatin, simvastatin, or rosuvastatin) for > 30 days prior to the index sepsis admission. We determined the association between statin and sepsis outcome by multivariate-adjusted Cox models and propensity score (PS)-matched analysis, using a 1:1:1 PS matching technique. Results: A total of 52,737 patients with sepsis fulfilled the inclusion criteria, of which 1,855 were prescribed atorvastatin, 916 were prescribed simvastatin, and 732 were prescribed rosuvastatin. Compared with nonusers, simvastatin (hazard ratio [HR], 0.72; 95{\%} CI, 0.58-0.90) and atorvastatin (HR, 0.78; 95{\%} CI, 0.68-0.90) were associated with an improved 30-day survival, whereas rosuvastatin was not (HR, 0.87; 95{\%} CI, 0.73-1.04). Using rosuvastatin as the reference, atorvastatin (HR, 0.79; 95{\%} CI, 0.64-0.99) and simvastatin (HR, 0.77; 95{\%} CI, 0.59-0.99) had superior effectiveness in preventing mortality. Conclusions: Compatible with in vitro experimental findings, our results suggest that the drug-specific effect of statins on sepsis is not correlated to their lipid-lowering potency.",
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AU - Yo, Chia Hung

AU - Tsai, Kuang Chau

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AB - Background: Whether statin treatment, proved by recent experimental studies to have an antimicrobial activity, exerts a drug- or a class-specific effect in sepsis remains unknown. Methods: Short-term mortality in patients with sepsis was analyzed using data from the National Health Insurance Research Database. Use of statins was defined as the cumulative use of a specific statin (atorvastatin, simvastatin, or rosuvastatin) for > 30 days prior to the index sepsis admission. We determined the association between statin and sepsis outcome by multivariate-adjusted Cox models and propensity score (PS)-matched analysis, using a 1:1:1 PS matching technique. Results: A total of 52,737 patients with sepsis fulfilled the inclusion criteria, of which 1,855 were prescribed atorvastatin, 916 were prescribed simvastatin, and 732 were prescribed rosuvastatin. Compared with nonusers, simvastatin (hazard ratio [HR], 0.72; 95% CI, 0.58-0.90) and atorvastatin (HR, 0.78; 95% CI, 0.68-0.90) were associated with an improved 30-day survival, whereas rosuvastatin was not (HR, 0.87; 95% CI, 0.73-1.04). Using rosuvastatin as the reference, atorvastatin (HR, 0.79; 95% CI, 0.64-0.99) and simvastatin (HR, 0.77; 95% CI, 0.59-0.99) had superior effectiveness in preventing mortality. Conclusions: Compatible with in vitro experimental findings, our results suggest that the drug-specific effect of statins on sepsis is not correlated to their lipid-lowering potency.

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