Systematic review of statins in sepsis: There is no evidence of dose response
Sandeep Gudibande, Tony Whitehouse, Catherine Snelson, Tonny Veenith, Morgan Quinn, Claire Moody, Bill Tunnicliffe, Zahid Khan, Mav Manji, Nick Murphy
High dose, mortality, low dose, sepsis, statin
Citation Information :
Gudibande S, Whitehouse T, Snelson C, Veenith T, Quinn M, Moody C, Tunnicliffe B, Khan Z, Manji M, Murphy N. Systematic review of statins in sepsis: There is no evidence of dose response. Indian J Crit Care Med 2016; 20 (9):534-541.
Objectives: Sepsis is a common cause of morbidity and mortality and is associated with significant costs to the healthcare organizations. We performed a systematic review and meta-analysis to assess whether high or low-dose statin therapy improved mortality in patients with sepsis.
Methods: The trials analyzed in this study were multicenter or single center randomized control studies using statins for sepsis in a hospital setting. The patients included were adults with suspected or confirmed infection.
Interventions: This study found eight randomized controlled trials where participants were given either a statin or placebo daily for 14–28 days, the duration of their illness, or until their death or discharge, which ever occurred first.
Primary and Secondary Outcomes Measured: This meta-analysis measured the effect of statin therapy on in hospital and 28 days mortality.
Results: In unselected patients, there was no demonstrable difference in the 28 days mortality (relative risk [RR] 0.88 95% confidence interval [CI], 0.70–1.12 and P = 0.16). There was also no significant difference between statin versus placebo for in-hospital mortality (RR 0.98 95% CI, 0.85–1.14 P = 0.36). When the studies where divided into low-dose and high-dose groups, there were no statistically significant differences for in-hospital mortality between low-dose statin versus placebo for (RR 0.81 CI 0.44–1.49 P = 0.27) or high-dose statin versus placebo (RR 0.99 95% CI 0.85–1.16, P = 0.28). There was no significant difference in adverse effects between the high- and low-dose groups.
Conclusions: In this meta-analysis, we found that the use of statins did not significantly improve either in-hospital mortality or 28-day mortality in patients with sepsis. In the low-dose group, there were fewer quality multicenter studies; hence, conclusions based on the results of this subgroup are limited.
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