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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 8  |  Issue : 6  |  Page : 250-251

Effect of statins on the mortality of bacteremic patients: A systematic review and meta-analysis of clinical trials


1 Department of Internal Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
2 Department of Internal Medicine, Reading Health System, West Reading, Pennsylvania, USA
3 Department of Internal Medicine, Universal College of Medical Sciences, Bhairahawa, Nepal

Date of Web Publication30-Jun-2016

Correspondence Address:
Dr. Paras Karmacharya
Department of Internal Medicine, Reading Health System, West Reading, Pennsylvania - 19611
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1947-2714.185034

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  Abstract 

Background: Statins modify inflammatory cell signaling during the immune response to infection. This has been considered as a pleotropic effect. Effects of statins in inflammatory conditions such as bacteremia have been found to be controversial. Aims: We examined the effect of statins on the mortality of bacteremia patients. Material and Methods: Major databases were searched for the pertinent clinical trials. Results: Six cohort studies comprising 7553 patients were included. Hospital mortality was lower (15.36% vs 22.28%) in patients on statin. Conclusions: There may be a potential role of statins in similar inflammatory and infective conditions.

Keywords: Bacteremia, infection, inflammation, mortality


How to cite this article:
Shrestha P, Poudel DR, Pathak R, Ghimire S, Dhital R, Aryal MR, Mahmood M, Karmacharya P. Effect of statins on the mortality of bacteremic patients: A systematic review and meta-analysis of clinical trials. North Am J Med Sci 2016;8:250-1

How to cite this URL:
Shrestha P, Poudel DR, Pathak R, Ghimire S, Dhital R, Aryal MR, Mahmood M, Karmacharya P. Effect of statins on the mortality of bacteremic patients: A systematic review and meta-analysis of clinical trials. North Am J Med Sci [serial online] 2016 [cited 2019 Nov 18];8:250-1. Available from: http://www.najms.org/text.asp?2016/8/6/250/185034


  Background Top


The pleiotropic effects of statins have been shown to modify inflammatory cell signaling during the immune response to infection. It has been postulated that statins can halt endothelial apoptosis, decrease isoprenylated proteins necessary for leukocyte cellular signaling, modulate endothelial cell adhesion molecules and proinflammatory cytokines, and regulate chemotactic proteins. [1],[2] Studies in the past have shown inconsistent results, with some studies suggesting beneficial effects of statins in inflammatory conditions such as bacteremia, [1],[3],[4],[5],[6],[7] pneumonia, [8] and sepsis, [9] whereas others showing potential harm. We, therefore, sought to conduct a systematic review and a meta-analysis regarding the effect of statins on the mortality of bacteremic patients.


  Materials and Methods Top


Relevant studies were identified through MEDLINE, EMBASE, Cochrane Library, Scopus, and clinicaltrials.gov electronic databases and hand-searched from inception through December 2014. Prospective and retrospective observational cohort studies examining the association between statin use (on hospital admission or previous users) and the outcomes of bacteremic patients were included. The outcome of interest was overall hospital mortality at the longest follow-up at each single study. The statistical analysis was performed using  Review Manager (RevMan) [Windows]. Version 5.2. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014. A P value of <0.05 was considered statistically significant. Study-specific risk ratios were calculated and combined using random-effects model meta-analysis. Between studies heterogeneity was assessed using the I 2 statistics. Quality assessment of cohort studies was performed using the Newcastle-Ottawa Scale.


  Results Top


Six cohort studies [1],[3],[4],[5],[6],[7] comprising 7553 patients were eligible. The overall hospital mortality was 15.36% (139/905) in patients on statin versus 22.28% (1481/6648) in patients not on a statin (Odds ratio = 0.49; 95% confidence interval = 0.30-0.81; I 2 =69%, P = 0.005) [Figure 1]. Quality analysis showed that all the included studies were of high or moderate quality (16.67% high and 83.33% moderate scores).
Figure 1: Meta-analysis of overall hospital mortality in statin vs. no statin group

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  Discussion Top


In previous studies, statins have inconsistently been shown to improve mortality among septic patients. Our study showed that statin treatment in bacteremic patients was associated with significantly lower mortality rates. This might be due to the long known pleotropic effects of statins.


  Conclusions Top


There may be a potential role for statins in similar inflammatory conditions. The optimum dose and type of statin (hydrophilic vs. lipophilic) and the mechanism by which statins potentially halt the inflammatory cascade remains an area of further study. Large, well designed, randomized controlled trials are warranted to provide more conclusive knowledge and potentially change clinical practice.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Previously presented at the ACP Annual Meeting, Boston, May 2015.

 
  References Top

1.
Nseir W, Mograbi J, Khateeb J, Abu-Elheja O, Bishara J, Jihad B, et al. The impact of prior long-term versus short-term statin use on the mortality of bacteraemic patients. Infection 2012;40:41-8.  Back to cited text no. 1
    
2.
De Loecker I, Preiser JC. Statins in the critically ill. Ann Intensive Care 2012;2:19.  Back to cited text no. 2
    
3.
López-Cortés LE, Gálvez-Acebal J, Del Toro MD, Velasco C, de Cueto M, Caballero FJ, et al. Effect of statin therapy in the outcome of bloodstream infections due to Staphylococcus aureus: A prospective cohort study. PloS One 2013;8:e82958.  Back to cited text no. 3
    
4.
Leung S, Pokharel R, Gong MN. Statins and outcomes in patients with bloodstream infection: A propensity-matched analysis. Crit Care Med 2012;40:1064-71.  Back to cited text no. 4
    
5.
Kruger P, Fitzsimmons K, Cook D, Jones M, Nimmo G. Statin therapy is associated with fewer deaths in patients with bacteraemia. Intensive Care Med 2006;32:75-9.  Back to cited text no. 5
    
6.
Thomsen RW, Hundborg HH, Johnsen SP, Pedersen L, Sørensen HT, Schønheyder HC, et al. Statin use and mortality within 180 days after bacteremia: A population-based cohort study. Crit Care Med 2006;34:1080-6.  Back to cited text no. 6
    
7.
Liappis AP, Kan VL, Rochester CG, Simon GL. The effect of statins on mortality in patients with bacteremia. Clin Infect Dis Off Publ Infect Dis Soc Am 2001;33:1352-7.  Back to cited text no. 7
    
8.
Cheng HH, Tang TT, He Q, Huang LJ, Lin XL, Chen M, et al. Beneficial effects of statins on outcomes in pneumonia: A systematic review and meta-analysis. Eur Rev Med Pharmacol Sci 2014;18:2294-305.  Back to cited text no. 8
    
9.
Tralhão AF, Cés de Souza-Dantas V, Salluh JI, Póvoa PM. Impact of statins in outcomes of septic patients: A systematic review. Postgrad Med 2014;126:45-58.  Back to cited text no. 9
    


    Figures

  [Figure 1]


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