Introduction
Materials and methods
Setting
Intensive care data
Preadmission use of statins
Other prognostic factors
Mortality data
Statistical analysis
Statin use n (%) | No statin use n (%) | |
---|---|---|
Overall
| 1882 (14.3%) | 10,601 (85.7%) |
Age group (years)
| ||
45-60 | 373 (19.8%) | 3725 (35.1%) |
61-75 | 1095 (58.2%) | 4421 (41.7%) |
76+ | 414 (22.0%) | 2455 (23.2%) |
Gender
| ||
Male | 1193 (63.4%) | 6085 (57.4%) |
Female | 689 (36.6%) | 4516 (42.6%) |
Comorbidity score*
| ||
Low | 283 (15.0%) | 3563 (33.6%) |
Medium | 862 (45.8%) | 4280 (40.4%) |
High | 737 (39.2%) | 2758 (26.0%) |
Comorbidity diagnosis**
| ||
Ischemic heart disease | 658 (35.0%) | 950 (9.0%) |
Congestive heart failure | 406 (21.6%) | 1113 (10.5%) |
Peripheral vascular disease | 451 (24.0%) | 1050 (9.9%) |
Cerebrovascular disease | 468 (24.9%) | 1393 (13.1%) |
COPD | 339 (18.0%) | 1836 (17.3%) |
Diabetes | 456 (24.2%) | 879 (8.3%) |
Cancer | 299 (15.9%) | 2401 (22.5%) |
Renal disease | 171 (9.0%) | 586 (5.4%) |
Alcoholism-related diseases | 137 (7.3%) | 1305 (12.3%) |
Cardiovascular drug use
| ||
ACE inhibitors | 1003 (53.3%) | 1860 (17.6%) |
Beta blockers | 983 (52.2%) | 1706 (16.1%) |
Low-dose aspirin | 336 (17.9%) | 674 (6.4%) |
Marital status
| ||
Married | 1141 (60.6%) | 5664 (53.4%) |
Divorced | 251 (13.3%) | 1512 (14.3%) |
Widowed | 345 (18.3%) | 2033 (19.2%) |
Never married | 139 (7.4%) | 1135 (10.7%) |
Unknown | 6 (0.3%) | 257 (2.4%) |
Statin use n (%) | No statin use n (%) | |
---|---|---|
Department
| ||
Medical | 771 (41.0%) | 4243 (40.0%) |
Surgical | 1111 (59.0%) | 6358 (60.0%) |
Main diagnosis
| ||
Infections | 43 (2.3%) | 253 (2.4%) |
Cancer | 163 (8.7%) | 1607 (15.2%) |
Diabetes | 30 (1.6%) | 129 (1.2%) |
Cardiovascular | 800 (42.5%) | 2828 (26.7%) |
Respiratory | 132 (7.0%) | 1049 (9.9%) |
Gastrointestinal | 163 (8.7%) | 1187 (11.2%) |
Trauma/poisoning | 136 (7.2%) | 1383 (13.1%) |
Other | 415 (22.0%) | 2165 (20.4%) |
Surgical status at ICU admission
| ||
Surgery within 7 days | 199 (10.6%) | 1347 (12.7%) |
Mechanical ventilation
| 1021 (54.3%) | 4796 (45.3%) |
Renal replacement therapy
| 223 (11.9%) | 867 (8.2%) |
Laboratory findings, median (IQR)*
| ||
Hemoglobin (ref; female: 7.4-9.6 mmol/l, male:8.4-10.8 mmol/l) | 7.10 (6.30-8.20) | 7.30 (6.40-8.30) |
Creatinine (ref 60-125 μmol/l) | 106.5 (80-165) | 93 (70-138) |
Bilirubin (ref 4-21 mmol/l) | 10 (7-16) | 12 (8-20) |
C-reactive protein (ref <10 mg/l) | 80 (15-250) | 97 (21-279) |
White blood cell count (ref 4.0-11.0 × 109/l) | 12.2 (8.8-16.0) | 12.3 (9.0-16.7) |
Total cholesterol (ref 3.0-6.7 mmol/l) | 4.6 (3.9-5.5) | 5.0 (4.1-5.9) |
Results
Descriptive data
30-day mortality
Number (n) | Mortality (%) | Crude MRR (95% CI) | Adjusted MRR (95% CI)* | |
---|---|---|---|---|
0 to 30 days
| ||||
Statin use | 1882 | 22.1% | 0.85 (0.76-0.96) | 0.76 (0.68-0.85) |
No statin use | 11,313 | 25.0% | 1 -- | 1 -- |
0 to 365 days
| ||||
Statin use | 1882 | 36.4% | 0.84 (0.76-0.93) | 0.78 (0.71-0.84) |
No statin use | 11,313 | 39.9% | 1 -- | 1 -- |
One-year mortality
Discussion
Existing studies
Limitations
Conclusions
Key messages
-
In experimental studies statins have shown to have anti-inflammatory, anti-thrombotic and immuno-modulating effects independent of lowering lipids, which may reduce mortality from critical illness.
-
In observational studies statin use has been associated with reduced mortality following major surgery and severe infections.
-
We found that preadmission statin use is associated with reduced short- and long-term mortality following intensive care.
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The beneficial effects may be most pronounced for users of simvastatin.