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DRUG INFORMATION ROUNDS

The Role of Statin Therapy in Sepsis

Clinical Pharmacy Specialist, St. Paul's Hospital, Vancouver, BC, Canada; Clinical Assistant Professor, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver

Ruth S Tsang, BSc(Pharm)

PharmD Student, University of British Columbia

I fan Kuo, BSc(Pharm)

Clinical Pharmacist, St. Paul's Hospital

Reprints: Dr. Chua, Department of Pharmacy, St. Paul's Hospital, 1081 Burrard St., Vancouver, BC, Canada, fax 604/806-8154, dchua{at}providencehealth.bc.ca

OBJECTIVE: To systematically review the evidence evaluating the role of statin therapy in sepsis.

DATA SOURCES: MEDLINE, EMBASE, and PubMed were searched (1980–January 2007) for English-language clinical trials that evaluated the use of statins and the development and treatment of sepsis in human subjects. Search terms included statin, HMG-CoA reductase inhibitor, bacteremia, sepsis, septic shock, septicemia, and severe sepsis. In addition, pertinent references from identified articles were obtained.

STUDY SELECTION AND DATA EXTRACTION: Only clinical trials with primary efficacy outcomes of mortality, incidence of sepsis, and severe sepsis were included.

DATA SYNTHESIS: Seven retrospective and 2 prospective cohort studies were included in this review. One was excluded because the patient population was not experiencing sepsis. Three studies demonstrated a reduced mortality with statin use while 2 other studies did not demonstrate this mortality benefit. One study suggested increased mortality with statin use in sepsis. Three studies showed a reduced incidence of development of sepsis or sepsis-related outcomes, while one study did not. The observational and retrospective nature of these studies and the higher rate of cardiovascular comorbidities in the statin groups may have allowed for a confounding influence. The conflicting results and heterogeneity between the studies makes the observed association between statin use and incidence of sepsis and sepsis-related mortality inconclusive. The clinical benefit of statin therapy in sepsis remains to be determined.

CONCLUSIONS: There is an association between statin use and a lower incidence of sepsis and sepsis-related mortality. However, a causal relationship between statin use and reduced sepsis-related mortality has not yet been established. Currently, statins cannot be recommended for sepsis prevention or treatment until controlled trials are performed.

Key Words: HMG-CoA reductase inhibitors, sepsis, septic shock, septicemia, statin

Published Online, March 27, 2007. www.theannals.com, DOI 10.1345/aph.1H550

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