Top

Published in:

01-05-2017 | Editorial

Statins in patients with sepsis and ARDS: is it over? We are not sure

Authors: Danny McAuley, Pierre-Emmanuel Charles, Laurent Papazian

Published in: Intensive Care Medicine | Issue 5/2017

Excerpt

Statins are lipid-lowering agents which act by inhibiting 3-hydroxy-3-methylglutaryl coenzyme A reductase and are generally used for cardiovascular prevention. Statins, however, also present anti-inflammatory and immunomodulating effects which could be of interest in sepsis and acute respiratory distress syndrome (ARDS). Many experimental investigations and some epidemiological studies support this theoretical beneficial effect. However, recent interventional studies which showed no benefit have been discouraging and do not support the use of statins in septic and/or ARDS patients. …

Moutzouri E, Tellis CC, Rousouli K, Liberopoulos EN, Milionis HJ, Elisaf MS, Tselepis AD (2012) Effect of simvastatin or its combination with ezetimibe on Toll-like receptor expression and lipopolysaccharide-induced cytokine production in monocytes of hypercholesterolemic patients. Atherosclerosis 225:381–387CrossRefPubMed

Wang Y, Zhang MX, Meng X, Liu FQ, Yu GS, Zhang C, Sun T, Wang XP, Li L, Wang YY, Ding SF, Yang JM, Zhang Y (2011) Atorvastatin suppresses LPS-induced rapid upregulation of Toll-like receptor 4 and its signaling pathway in endothelial cells. Am J Physiol Heart Circ Physiol 300:H1743–H1752CrossRefPubMed

Ou SY, Chu H, Chao PW, Ou SM, Lee YJ, Kuo SC, Li SY, Shih CJ, Chen YT (2014) Effect of the use of low and high potency statins and sepsis outcomes. Intensive Care Med 40:1509–1517CrossRefPubMed

Deshpande A, Pasupuleti V, Rothberg MB (2015) Statin therapy and mortality from sepsis: a meta-analysis of randomized trials. Am J Med 128(410–417):e411

Kruger P, Bailey M, Bellomo R, Cooper DJ, Harward M, Higgins A, Howe B, Jones D, Joyce C, Kostner K, McNeil J, Nichol A, Roberts MS, Syres G, Venkatesh B, ANZ-STATInS Investigators–ANZICS Clinical Trials Group (2013) A multicenter randomized trial of atorvastatin therapy in intensive care patients with severe sepsis. Am J Respir Crit Care Med 187:743–750CrossRefPubMed

Schurr JW, Wu W, Smith-Hannah A, Smith CJ, Barrera R (2016) Incidence of sepsis and mortality with prior exposure of HMG-COA reductase inhibitors in a surgical intensive care population. Shock 45:10–15CrossRefPubMed

Bruyere R, Vigneron C, Prin S, Pechinot A, Quenot JP, Aho S, Papazian L, Charles PE (2014) Impact of prior statin therapy on the outcome of patients with suspected ventilator-associated pneumonia: an observational study. Crit Care 18:R83CrossRefPubMedPubMedCentral

Papazian L, Roch A, Charles PE, Penot-Ragon C, Perrin G, Roulier P, Goutorbe P, Lefrant JY, Wiramus S, Jung B, Perbet S, Hernu R, Nau A, Baldesi O, Allardet-Servent J, Baumstarck K, Jouve E, Moussa M, Hraiech S, Guervilly C, Forel JM, STATIN-VAP Study Group (2013) Effect of statin therapy on mortality in patients with ventilator-associated pneumonia: a randomized clinical trial. JAMA 310:1692–1700CrossRefPubMed

Craig TR, Duffy MJ, Shyamsundar M, McDowell C, O’Kane CM, Elborn JS, McAuley DF (2011) A randomized clinical trial of hydroxymethylglutaryl-coenzyme a reductase inhibition for acute lung injury (The HARP Study). Am J Respir Crit Care Med 183:620–626CrossRefPubMed

10.

Shyamsundar M, McKeown ST, O’Kane CM, Craig TR, Brown V, Thickett DR, Matthay MA, Taggart CC, Backman JT, Elborn JS, McAuley DF (2009) Simvastatin decreases lipopolysaccharide-induced pulmonary inflammation in healthy volunteers. Am J Respir Crit Care Med 179:1107–1114CrossRefPubMedPubMedCentral

11.

Calfee CS, Delucchi K, Parsons PE, Thompson BT, Ware LB, Matthay MA, NHLBI ARDS Network (2014) Subphenotypes in acute respiratory distress syndrome: latent class analysis of data from two randomised controlled trials. Lancet Respir Med 2:611–620CrossRefPubMedPubMedCentral

12.

McAuley DF, Laffey JG, O’Kane CM, Perkins GD, Mullan B, Trinder TJ, Johnston P, Hopkins PA, Johnston AJ, McDowell C, McNally C, HARP-2 Investigators, Irish Critical Care Trials Group (2014) Simvastatin in the acute respiratory distress syndrome. N Engl J Med 371:1695–1703CrossRefPubMed

13.

National Heart, Lung, and Blood Institute ARDS Clinical Trials Network, Truwit JD, Bernard GR, Steingrub J, Matthay MA, Liu KD, Albertson TE, Brower RG, Shanholtz C, Rock P, Douglas IS, deBoisblanc BP, Hough CL, Hite RD, Thompson BT (2014) Rosuvastatin for sepsis-associated acute respiratory distress syndrome. N Engl J Med 370:2191–2200CrossRef

14.

Iwashyna TJ, Burke JF, Sussman JB, Prescott HC, Hayward RA, Angus DC (2015) Implications of heterogeneity of treatment effect for reporting and analysis of randomized trials in critical care. Am J Respir Crit Care Med 192:1045–1051CrossRefPubMedPubMedCentral

15.

Chopra V, Rogers MA, Buist M, Govindan S, Lindenauer PK, Saint S, Flanders SA (2012) Is statin use associated with reduced mortality after pneumonia? A systematic review and meta-analysis. Am J Med 125:1111–1123CrossRefPubMed

Title: Statins in patients with sepsis and ARDS: is it over? We are not sure
Authors: Danny McAuley
Pierre-Emmanuel Charles
Laurent Papazian
Publication date: 01-05-2017
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 5/2017
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-016-4454-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Statins in patients with sepsis and ARDS: is it over? We are not sure

Excerpt

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Excerpt

Please log in to get access to this content

Other articles of this Issue 5/2017

Statins in patients with sepsis and ARDS: is it over? No

One ring to rule them all: education in ICU palliative care

ICU experience for patients’ relatives: is information all that matters?

Left ventricular systolic dysfunction during septic shock: the role of loading conditions

ICU specialists facing terrorist attack: the Nice experience

Association of do-not-resuscitate order and survival in patients with severe sepsis and/or septic shock