Estatinas y sepsis

Estatinas y sepsis Statins and sepsis. Gao F, Linhartova L, Johnston AM, Thickett DR. Academic Department of Anaesthesia, Critical Care, and Pain, Heart of England NHS Foundation Trust, University of Warwick, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, UK.f.g.smith@bham.ac.uk Br J Anaesth. 2008 Mar;100(3):288-98. Abstract Severe sepsis and septic shock is common and frequently fatal. Over the last few years, the primary treatments demonstrated to improve outcome from several major clinical trials have finally emerged. However, translating these recent therapeutic advances to routine clinical practice has proven controversial, and new approaches of additional strategies are continued to be developed. Given their pleiotropic effects related to many pathophysiological determinants of sepsis, statin therapy could be the next step in the search for adjuvant therapy. A future challenge may be to test both the efficacy and the safety by large randomized controlled clinical trials ascertaining the effects of statins administered at the onset of sepsis and in patients with severe sepsis or septic shock admitted into intensive care units http://bja.oxfordjournals.org/content/100/3/288.full.pdf+html   Efectos de descontinuar o continuar la terapia previa con estatinas en sepsis severa y shock séptico: un estudio retrospectivo de cohortes. Effects of discontinuing or continuing ongoing statin therapy in severe sepsis and septic shock: a retrospective cohort study. Mekontso Dessap A, Ouanes I, Rana N, Borghi B, Bazin C, Katsahian S, Hulin A, Brun-Buisson C. Crit Care. 2011 Jul 18;15(4):R171. Abstract INTRODUCTION: Recent publications suggest potential benefits from statins as a preventive or adjuvant therapy in sepsis. Whether ongoing statin therapy should be continued or discontinued in patients admitted in the intensive care unit (ICU) for sepsis is open to question. METHODS: We retrospectively compared patients with severe sepsis and septic shock in whom statin therapy had been discontinued or continued. The primary endpoint was the number of organ failure-free days at day 14. Secondary end-points included hospital mortality and safety. The association of statin continuation with outcome was evaluated for crude analysis and after propensity score matching and adjustment. We also measured plasma atorvastatin concentrations in a separate set of ICU septic patients continuing the drug. RESULTS: Patients in whom statin therapy had been continued in the ICU (n=44) had significantly more organ failure-free days (11 [6-14] vs. 6 [0-12], mean difference of 2.34, 95%CI from 0.47 to 5.21, P = 0.03) as compared to others (n=32). However, there were important imbalances between groups, with more hospital-acquired infections, more need for surgery before ICU admission, and a trend towards more septic shock at ICU admission in the discontinuation group. The significant association of statin continuation with organ failure free days found in the crude analysis did not persist after propensity-matching or multivariable adjustment: beta coefficients [95% CI] of 2.37 [-0.96 to 5.70] (P =0.20) and 2.24 [-0.43 to 4.91] (P =0.11) respectively. We found particularly high pre-dose and post-dose atorvastatin concentrations in ICU septic patients continuing the drug. CONCLUSIONS: Continuing statin therapy in ICU septic patients was not associated with reduction in the severity of organ failure after matching and adjustment. In addition, the very high plasma concentrations achieved during continuation of statin treatment advocates some caution. http://ccforum.com/content/pdf/cc10317.pdf    Estatinas, inflamación, y sepsis: hipótesis Statins, inflammation, and sepsis: hypothesis. Almog Y. Medical Intensive Care Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel.almogya@bgumail.bgu.ac.il Chest. 2003 Aug;124(2):740-3. Abstract Sepsis and septic shock are complex inflammatory syndromes. Multiple cellular activation processes are involved, and many humoral cascades are triggered. Statins have anti-inflammatory properties. Our preliminary observations indicate that patients receiving therapy with statins may have a lower incidence of severe sepsis. We hypothesize that statins have a strong protective effect against sepsis by virtue of diverse anti-inflammatory effects that are independent of their lipid-lowering ability. http://chestjournal.chestpubs.org/content/124/2/740.full.pdf+html

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