Abstract
Severe sepsis is a leading cause of death in the developed world. There is limited clinical data whether medications such as statins, angiotensin converting enzyme inhibitors (ACEIs), and angiotensin II receptor blockers (ARBs) impact sepsis-related outcomes.
We conducted a retrospective cohort study using Department of Veterans Affairs data of patients > 65 years hospitalized with severe sepsis. We propensity matched for the 3 medications simultaneously to examine the relationships of these medications on the outcomes of 30-day mortality and use of invasive mechanical ventilation.
Of the 9,527 potentially eligible patients we matched 2,422 cases to 2,422 controls. Mean age was 74.2 years, and 99% were male. Of the matched cohort, 59% were in the ICU within 24 hours, 35% received invasive mechanical ventilation, and 30-day mortality was 40%. We found that prior outpatient use of ARBs was associated with decreased 30-day mortality (odds ratio 0.58, 95% confidence interval 0.37-0.91) and decreased use of mechanical ventilation (0.66, 0.45 - 0.96). However, for both statins and ACEIs we did not find significant differences in 30-day mortality (statins-0.91, 0.79-1.03; ACEI- 0.95 0.83-1.09) or mechanical ventilation (statins- 0.91, 0.78-1.07; ACEI- 0.99, 0.84-1.16).
These findings suggest a beneficial association between use of ARBs and sepsis-related outcomes however, unlike prior studies, no association was seen with the use of statins or ACEIs. Additional research is needed to assess if these medications may be protective for patients hospitalized with sepsis.
- © 2013 ERS
