Preadmission statin use improves the outcome of less severe sepsis patients - A population-based propensity score matched cohort study

National Taiwan University Hospital Health Economics and Outcome Research Group

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background Randomized controlled trials on the post-admission use of statins in sepsis patients have not shown a survival benefit. Whether preadmission use of statins would confer any beneficial effects in sepsis patients has not been well studied. Methods We conducted a population-based cohort study on a national health insurance claims database between 1999 and 2011. Sepsis patients were identified by ICD-9 codes compatible with the third International consensus definitions for sepsis. Use of statin was defined as the cumulative use of any statin for more than 30 days before the indexed sepsis admission. We determined the association between statin use and sepsis outcome by multivariate-adjusted Cox proportional hazard models and propensity score matched analysis. To minimize baseline imbalance between statin users and non-statin users, we matched/adjusted for social economic status, comorbidities, proxies for healthy lifestyle, health care facility utilization, and use of medications. Results We identified 52 737 sepsis patients, of which 3599 received statin treatment. Statins use was associated with a reduced 30-day mortality after multivariable adjustment (HR 0.86, 95% CI, 0.78-0.94) and propensity score matching (HR, 0.88; 95% CI, 0.78-0.99). On subgroup analysis, the beneficial effects of statins were not significant in patients receiving ventilator support or requiring ICU admission. Conclusions In this national cohort study, preadmission statin therapy before sepsis development was associated with a 12% reduction in mortality when compared with patients who never received a statin. There were no consistent beneficial effects of statins in all patient subgroups.

Original languageEnglish
Pages (from-to)645-654
Number of pages10
JournalBritish Journal of Anaesthesia
Volume119
Issue number4
DOIs
Publication statusPublished - Oct 1 2017

Fingerprint

Hydroxymethylglutaryl-CoA Reductase Inhibitors
Propensity Score
Sepsis
Cohort Studies
Population
International Classification of Diseases
Patient Acceptance of Health Care
Social Adjustment
Mortality
Health Facilities
National Health Programs
Proxy
Mechanical Ventilators
Proportional Hazards Models
Comorbidity

Keywords

  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • propensity score
  • sepsis

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Preadmission statin use improves the outcome of less severe sepsis patients - A population-based propensity score matched cohort study. / National Taiwan University Hospital Health Economics and Outcome Research Group.

In: British Journal of Anaesthesia, Vol. 119, No. 4, 01.10.2017, p. 645-654.

Research output: Contribution to journalArticle

National Taiwan University Hospital Health Economics and Outcome Research Group. / Preadmission statin use improves the outcome of less severe sepsis patients - A population-based propensity score matched cohort study. In: British Journal of Anaesthesia. 2017 ; Vol. 119, No. 4. pp. 645-654.
@article{9be8829bf5594562b7b5d47efc0b2c39,
title = "Preadmission statin use improves the outcome of less severe sepsis patients - A population-based propensity score matched cohort study",
abstract = "Background Randomized controlled trials on the post-admission use of statins in sepsis patients have not shown a survival benefit. Whether preadmission use of statins would confer any beneficial effects in sepsis patients has not been well studied. Methods We conducted a population-based cohort study on a national health insurance claims database between 1999 and 2011. Sepsis patients were identified by ICD-9 codes compatible with the third International consensus definitions for sepsis. Use of statin was defined as the cumulative use of any statin for more than 30 days before the indexed sepsis admission. We determined the association between statin use and sepsis outcome by multivariate-adjusted Cox proportional hazard models and propensity score matched analysis. To minimize baseline imbalance between statin users and non-statin users, we matched/adjusted for social economic status, comorbidities, proxies for healthy lifestyle, health care facility utilization, and use of medications. Results We identified 52 737 sepsis patients, of which 3599 received statin treatment. Statins use was associated with a reduced 30-day mortality after multivariable adjustment (HR 0.86, 95{\%} CI, 0.78-0.94) and propensity score matching (HR, 0.88; 95{\%} CI, 0.78-0.99). On subgroup analysis, the beneficial effects of statins were not significant in patients receiving ventilator support or requiring ICU admission. Conclusions In this national cohort study, preadmission statin therapy before sepsis development was associated with a 12{\%} reduction in mortality when compared with patients who never received a statin. There were no consistent beneficial effects of statins in all patient subgroups.",
keywords = "Hydroxymethylglutaryl-CoA Reductase Inhibitors, propensity score, sepsis",
author = "{National Taiwan University Hospital Health Economics and Outcome Research Group} and Lee, {M. G.} and Lee, {C. C.} and Lai, {C. C.} and Hsu, {T. C.} and L. Porta and M. Lee and Chang, {S. S.} and Chien, {K. L.} and Chen, {Y. M.}",
year = "2017",
month = "10",
day = "1",
doi = "10.1093/bja/aex294",
language = "English",
volume = "119",
pages = "645--654",
journal = "British Journal of Anaesthesia",
issn = "0007-0912",
publisher = "Oxford University Press",
number = "4",

}

TY - JOUR

T1 - Preadmission statin use improves the outcome of less severe sepsis patients - A population-based propensity score matched cohort study

AU - National Taiwan University Hospital Health Economics and Outcome Research Group

AU - Lee, M. G.

AU - Lee, C. C.

AU - Lai, C. C.

AU - Hsu, T. C.

AU - Porta, L.

AU - Lee, M.

AU - Chang, S. S.

AU - Chien, K. L.

AU - Chen, Y. M.

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Background Randomized controlled trials on the post-admission use of statins in sepsis patients have not shown a survival benefit. Whether preadmission use of statins would confer any beneficial effects in sepsis patients has not been well studied. Methods We conducted a population-based cohort study on a national health insurance claims database between 1999 and 2011. Sepsis patients were identified by ICD-9 codes compatible with the third International consensus definitions for sepsis. Use of statin was defined as the cumulative use of any statin for more than 30 days before the indexed sepsis admission. We determined the association between statin use and sepsis outcome by multivariate-adjusted Cox proportional hazard models and propensity score matched analysis. To minimize baseline imbalance between statin users and non-statin users, we matched/adjusted for social economic status, comorbidities, proxies for healthy lifestyle, health care facility utilization, and use of medications. Results We identified 52 737 sepsis patients, of which 3599 received statin treatment. Statins use was associated with a reduced 30-day mortality after multivariable adjustment (HR 0.86, 95% CI, 0.78-0.94) and propensity score matching (HR, 0.88; 95% CI, 0.78-0.99). On subgroup analysis, the beneficial effects of statins were not significant in patients receiving ventilator support or requiring ICU admission. Conclusions In this national cohort study, preadmission statin therapy before sepsis development was associated with a 12% reduction in mortality when compared with patients who never received a statin. There were no consistent beneficial effects of statins in all patient subgroups.

AB - Background Randomized controlled trials on the post-admission use of statins in sepsis patients have not shown a survival benefit. Whether preadmission use of statins would confer any beneficial effects in sepsis patients has not been well studied. Methods We conducted a population-based cohort study on a national health insurance claims database between 1999 and 2011. Sepsis patients were identified by ICD-9 codes compatible with the third International consensus definitions for sepsis. Use of statin was defined as the cumulative use of any statin for more than 30 days before the indexed sepsis admission. We determined the association between statin use and sepsis outcome by multivariate-adjusted Cox proportional hazard models and propensity score matched analysis. To minimize baseline imbalance between statin users and non-statin users, we matched/adjusted for social economic status, comorbidities, proxies for healthy lifestyle, health care facility utilization, and use of medications. Results We identified 52 737 sepsis patients, of which 3599 received statin treatment. Statins use was associated with a reduced 30-day mortality after multivariable adjustment (HR 0.86, 95% CI, 0.78-0.94) and propensity score matching (HR, 0.88; 95% CI, 0.78-0.99). On subgroup analysis, the beneficial effects of statins were not significant in patients receiving ventilator support or requiring ICU admission. Conclusions In this national cohort study, preadmission statin therapy before sepsis development was associated with a 12% reduction in mortality when compared with patients who never received a statin. There were no consistent beneficial effects of statins in all patient subgroups.

KW - Hydroxymethylglutaryl-CoA Reductase Inhibitors

KW - propensity score

KW - sepsis

UR - http://www.scopus.com/inward/record.url?scp=85032862810&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85032862810&partnerID=8YFLogxK

U2 - 10.1093/bja/aex294

DO - 10.1093/bja/aex294

M3 - Article

VL - 119

SP - 645

EP - 654

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

SN - 0007-0912

IS - 4

ER -