Skip to main content
Erschienen in: Intensive Care Medicine 8/2006

01.08.2006 | Brief Report

Association of statin therapy and increased survival in patients with multiple organ dysfunction syndrome

verfasst von: Hendrik Schmidt, Ralf Hennen, Alexander Keller, Martin Russ, Ursula Müller-Werdan, Karl Werdan, Michael Buerke

Erschienen in: Intensive Care Medicine | Ausgabe 8/2006

Einloggen, um Zugang zu erhalten

Abstract

Objective

The multiple organ dysfunction syndrome (MODS) is the sequential failure of several organ systems after a trigger event, such as sepsis, pneumonia or cardiogenic shock. Even today, mortality is high. Statin therapy is associated with reduction of inflammation and subsequent rates of severe sepsis and ICU admission of patients admitted to hospital with presumed or documented acute bacterial infection. Our study aimed to characterize a potential survival benefit by statin therapy in MODS patients.

Design

Retrospective cohort study.

Setting

Twelve-bed medical intensive care unit in a university center.

Patients

Forty score-defined MODS patients under statin treatment and 80 age- and sex-matched score-defined MODS patients without statin treatment. Inclusion criterion was an APACHE II score ≥ 20 at admission to ICU.

Interventions

Assessment of statin treatment and calculation of disease severity by scoring. The patients were followed up for 28-day mortality as well as for hospital mortality.

Measurements and results

The MODS severity was equally pronounced in both groups. There were 42/80 deaths in the group without statin treatment and 13/40 deaths in the statin group (28-day mortality 53% vs. 33%, p = 0.03). Cox proportional hazard analysis revealed a hazard ratio of 0.53 (95% CI 0.29–0.99, p = 0.04). Hospital mortality was calculated at 72% (non-statin group) vs. 35% (statin group; chi-square  = 15.6, p < 0.0001). The overall hospital mortality was 60%.

Conclusions

Patients under statin treatment developing MODS might have a better outcome than patients without statin therapy, probably by reduction of inflammatory responses and increase of vagal activity in MODS.
Literatur
1.
Zurück zum Zitat Mekontso-Dessap A, Brun-Buisson C (2006) Statins: the next step in adjuvant therapy for sepsis? Intensive Care Med 32:11–14PubMedCrossRef Mekontso-Dessap A, Brun-Buisson C (2006) Statins: the next step in adjuvant therapy for sepsis? Intensive Care Med 32:11–14PubMedCrossRef
2.
Zurück zum Zitat Merx MW, Weber C (2005) Statins: a preventive strike against sepsis in patients with cardiovascular disease? Lancet DOI: 10.1016/S0140–6736(06) Merx MW, Weber C (2005) Statins: a preventive strike against sepsis in patients with cardiovascular disease? Lancet DOI: 10.1016/S0140–6736(06)
3.
Zurück zum Zitat Warnholtz A, Genth-Zotz S, Münzel T (2005) Should treatment of sepsis include statins? Circulation 111:1735–1737PubMedCrossRef Warnholtz A, Genth-Zotz S, Münzel T (2005) Should treatment of sepsis include statins? Circulation 111:1735–1737PubMedCrossRef
4.
Zurück zum Zitat Moerer O, Schmid A, Hofmann M, Herklotz A, Reinhart K, Werdan K, Schneider H, Burchardi H (2000) Direct costs of severe sepsis in three German intensive care units based on retrospective electronic patient record analysis of resource use. Intensive Care Med 28:1440–1446CrossRef Moerer O, Schmid A, Hofmann M, Herklotz A, Reinhart K, Werdan K, Schneider H, Burchardi H (2000) Direct costs of severe sepsis in three German intensive care units based on retrospective electronic patient record analysis of resource use. Intensive Care Med 28:1440–1446CrossRef
5.
Zurück zum Zitat Pruefer D, Makowski J, Schnell M, Buerke U, Dahm M, Oelert H, Sibelius U, Grandel U, Grimminger F, Seeger W, Meyer J, Darius H, Buerke M (2002) Simvastatin inhibits inflammatory properties of Staphylococcus aureus alpha-toxin. Circulation 106:2104–2110PubMedCrossRef Pruefer D, Makowski J, Schnell M, Buerke U, Dahm M, Oelert H, Sibelius U, Grandel U, Grimminger F, Seeger W, Meyer J, Darius H, Buerke M (2002) Simvastatin inhibits inflammatory properties of Staphylococcus aureus alpha-toxin. Circulation 106:2104–2110PubMedCrossRef
6.
Zurück zum Zitat Merx MW, Liehn EA; Janssens U, Lütticken R, Schrader J, Hanrath P, Weber C (2004) HMG-CoA reductase inhibitor simvastatin profoundly improves survival in a murine model of sepsis. Circulation 109:2560–2565PubMedCrossRef Merx MW, Liehn EA; Janssens U, Lütticken R, Schrader J, Hanrath P, Weber C (2004) HMG-CoA reductase inhibitor simvastatin profoundly improves survival in a murine model of sepsis. Circulation 109:2560–2565PubMedCrossRef
7.
Zurück zum Zitat Almog Y, Shefer A, Novack V, Maimon N, Barski L, Eizinger M, Friger M, Zeller L, Danon A (2004) Prior statin therapy is associated with a decreased rate of severe sepsis. Circulation 110:880–885PubMedCrossRef Almog Y, Shefer A, Novack V, Maimon N, Barski L, Eizinger M, Friger M, Zeller L, Danon A (2004) Prior statin therapy is associated with a decreased rate of severe sepsis. Circulation 110:880–885PubMedCrossRef
8.
Zurück zum Zitat Kruger P, Fitzsimmons K, Cook D, Jones M, Nimmo G (2006) Statin therapy is associated with fewer deaths in patients with bacteraemia. Intensive Care Med 32:75–79PubMedCrossRef Kruger P, Fitzsimmons K, Cook D, Jones M, Nimmo G (2006) Statin therapy is associated with fewer deaths in patients with bacteraemia. Intensive Care Med 32:75–79PubMedCrossRef
9.
Zurück zum Zitat Schmidt H, Hennen R, Keller A, Rauchhaus M, Russ M, Mueller-Werdan U, Werdan K, Buerke M (2005) Association of statin therapy and increased survival in patients with multiple organ dysfunction syndrome. Intensive Care Med 31 [Suppl 1]: A10 Schmidt H, Hennen R, Keller A, Rauchhaus M, Russ M, Mueller-Werdan U, Werdan K, Buerke M (2005) Association of statin therapy and increased survival in patients with multiple organ dysfunction syndrome. Intensive Care Med 31 [Suppl 1]: A10
10.
Zurück zum Zitat Schmidt H, Müller-Werdan U, Hoffmann T, Francis DP, Piepoli MF, Rauchhaus M, Prondzinsky R, Loppnow H, Buerke M, Hoyer D, Werdan K (2005) Autonomic dysfunction predicts mortality in patients with multiple organ dysfunction syndrome of different age groups. Crit Care Med 33:1994–2002PubMedCrossRef Schmidt H, Müller-Werdan U, Hoffmann T, Francis DP, Piepoli MF, Rauchhaus M, Prondzinsky R, Loppnow H, Buerke M, Hoyer D, Werdan K (2005) Autonomic dysfunction predicts mortality in patients with multiple organ dysfunction syndrome of different age groups. Crit Care Med 33:1994–2002PubMedCrossRef
11.
Zurück zum Zitat Schmidt H, Müller-Werdan U, Nuding S, Hoffmann T, Francis DP, Hoyer D, Rauchhaus M, Werdan K (2004) Impaired chemoreflex sensitivity in adult patients with multiple organ dysfunction syndrome – the potential role of disease severity. Intensive Care Med 30:665–672PubMedCrossRef Schmidt H, Müller-Werdan U, Nuding S, Hoffmann T, Francis DP, Hoyer D, Rauchhaus M, Werdan K (2004) Impaired chemoreflex sensitivity in adult patients with multiple organ dysfunction syndrome – the potential role of disease severity. Intensive Care Med 30:665–672PubMedCrossRef
12.
Zurück zum Zitat Hackam DG,Mamdani M, Li P, Redelmeier DA (2006) Statins and sepsis in patients with cardiovascular disease: a population-based cohort analysis. Lancet 367:413–418PubMedCrossRef Hackam DG,Mamdani M, Li P, Redelmeier DA (2006) Statins and sepsis in patients with cardiovascular disease: a population-based cohort analysis. Lancet 367:413–418PubMedCrossRef
13.
Zurück zum Zitat Liappis AP, Kan VL, Rochester CG, Simon GL (2001) The effect of statins on mortality in patients with bacteremia. Clin Infect Dis 33:1352–1357PubMedCrossRef Liappis AP, Kan VL, Rochester CG, Simon GL (2001) The effect of statins on mortality in patients with bacteremia. Clin Infect Dis 33:1352–1357PubMedCrossRef
14.
Zurück zum Zitat Fernandez R, De Pedro VJ, Artigas A (2006) Statin therapy prior to ICU admission: protection against infection or a severity marker? Intensive Care Med 32:160–164PubMedCrossRef Fernandez R, De Pedro VJ, Artigas A (2006) Statin therapy prior to ICU admission: protection against infection or a severity marker? Intensive Care Med 32:160–164PubMedCrossRef
15.
Zurück zum Zitat Steiner S, Speidl WS, Pleiner J, Seidinger D, Zorn G, Kaun C, Wojta J, Huber K, Minar E, Wolzt M, Kopp CW (2005) Simvastatin blunts endotoxin-induced tissue factor in vivo. Circulation 111:1841–1846PubMedCrossRef Steiner S, Speidl WS, Pleiner J, Seidinger D, Zorn G, Kaun C, Wojta J, Huber K, Minar E, Wolzt M, Kopp CW (2005) Simvastatin blunts endotoxin-induced tissue factor in vivo. Circulation 111:1841–1846PubMedCrossRef
Metadaten
Titel
Association of statin therapy and increased survival in patients with multiple organ dysfunction syndrome
verfasst von
Hendrik Schmidt
Ralf Hennen
Alexander Keller
Martin Russ
Ursula Müller-Werdan
Karl Werdan
Michael Buerke
Publikationsdatum
01.08.2006
Verlag
Springer-Verlag
Erschienen in
Intensive Care Medicine / Ausgabe 8/2006
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-006-0246-y

Weitere Artikel der Ausgabe 8/2006

Intensive Care Medicine 8/2006 Zur Ausgabe

Announcements

Announcements

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.