This article is part of Pulmonology Advisor‘s coverage of the CHEST 2019 meeting, taking place in New Orleans, LA. Our staff will report on medical research related to asthma, COPD, critical care medicine, and more conducted by experts in the field. Check back regularly for more news from CHEST 2019.
NEW ORLEANS — Statin therapy before septic shock may decrease the risk for acute respiratory distress syndrome (ARDS) significantly, according to the results of a retrospective study presented at the CHEST Annual Meeting held from October 19 to 23, in New Orleans, Louisiana.
Researchers evaluated patients with septic shock in a community hospital intensive care unit (ICU) from December 2013 to December 2014. Statin use prior to hospital admission was determined by the home medication list. Outcomes were defined as ARDS, ICU and hospital length of stay, and ventilator days. In addition, a multivariate regression analysis was conducted with statins prior to admission as the independent variable and ARDS as the dependent variable.
A total of 128 patients (mean age, 67 years; 61% women) were included in the study. Intra-abdominal infection, pneumonia, and urinary tract infection were among the most common causes of septic shock. More than half of the patients required mechanical ventilation and the mortality rate was 50%. Patients who were taking statins were more likely to be older (73.7±10 vs 64.4±18; P =.002), have diabetes (59% vs 40%; P =.033), take aspirin (50% vs 19%; P <.001), take beta-blockers (47.65 vs 26%; P =.013), have higher serum albumin levels (2.6±0.76 g/dL vs 2.1±0.74 g/dL), and were less likely to have cirrhosis (0% vs 12%; P =.021).
ARDS was less likely to develop in patients who were taking a statin (7% vs 29%; P =.005); however, in the subset of patients who took statins prior to admission, there was no significance in the incidence of ARDS based on the continuation of statins on ICU admission (4.2% vs 11%; P =.387).
When the researchers controlled for age, gender, race, diabetes, aspirin, beta-blockers, cirrhosis, pneumonia, and albumin and lactate levels, statin use prior to admission was associated with a significantly decreased risk for ARDS (odds ratio, 0.18; P =.03). However, statin use prior to admission was not associated with significant reductions in length of stay (12.8±13.2 vs 15.4±16.1; P =.365), ICU length of stay (4.7±4.8 vs 6.0±6.3; P =.244), or ventilator days (3.1±5.6 vs 3.8±5.7; P =.528).
The researchers concluded that statins appear to reduce the risk for ARDS when taken prior to septic shock, but further investigation into the mechanism by which the agents modulate the pathogenesis of ARDS is needed.
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Plasencia JT, Chacon A, Garnet B, Donath E, Wellikoff A, Mirsaeidi M. Statin therapy prior to septic shock is associated with a reduced risk of ARDS. Presented at: CHEST Annual Meeting 2019; October 19-23, 2019; New Orleans, LA. Abstract 976.