危重病人入院前使用他汀类药物与90天死亡率：一项回顾性关联研究
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Preadmission Statin Use and 90-day Mortality in the Critically Ill：A Retrospective Association Study
背景与目的
这项研究的目的是研究入院前使用他汀类药物与危重病患者90天死亡率之间的关系，并调查这种相关性是否因他汀类药物和剂量不同而有所不同。我们假设入院前使用他汀类药物与90天死亡率降低相关。
方 法
这项回顾性队列研究分析了2012年1月至2017年12月期间在一家三级医院重症监护病房住院的所有成年患者的医疗记录。收集数据，包括入院前他汀类的使用，他汀药物亚型和每日剂量，并检查这些变量与患者在ICU入院后90天死亡率之间的关系。主要结果是90天死亡率。
结 果
共纳入24，928名患者(使用他汀类药物的7，396名患者和使用非他汀类药物的17，532名患者)。在倾向得分匹配后，最终纳入5354名使用他汀类药物的患者和7，758名使用非他汀类药物的患者。非他汀组90天死亡率(918/7，758；11.8%)明显高于他汀组(4/5，354；8.5%；P<0.001)。COX回归分析显示，服用他汀类药物的患者90d死亡率低于未服用他汀类药物的患者(危险比：0.70，95%CI：0.63~0.79；P<0.001)。使用瑞舒伐他汀可降低42%的90天死亡率(风险比：0.58，95%CI：0.47-0.72；P<0.001)。他汀类药物每日剂量与90天死亡率的相关性之间没有具体的显着差异。在竞争风险分析中，他汀类药物使用者的90天非心血管死亡率的风险比非他汀类药物使用者低32%(危险比：0.68，95%CI：0.60至0.78；P<0.001)。同时，90天心血管死亡率与他汀类药物的使用没有明显的相关性。
结 论
入院前使用他汀类药物与降低90天死亡率相关。这种联系在瑞舒伐他汀组和90天非心血管疾病因素致死的死亡率中更为明显；每日剂量强度没有发现差异。
原始文献摘要
Oh T K, Song I A, Cho Y J, et al. Preadmission Statin Therapy Is Associated with a Lower Incidence of Acute Kidney Injury in Critically Ill Patients: A Retrospective Observational Study[J]. Journal of Clinical Medicine, 8(1).
Background: This study aimed to examine the association between preadmission statin use and 90-day mortality in critically ill patients and to investigate whether this association differed according to statin type and dose. We hypothesized that preadmission statin use was associated with lower 90-day mortality.
Methods: This retrospective cohort study analyzed the medical records of all adult patients admitted to the intensive care unit in a single tertiary academic hospital between January 2012 and December 2017. Data including preadmission statin use, statin subtype, and daily dosage were collected, and the associations between these variables and 90-day mortality after intensive care unit admission were examined. The primary endpoint was 90-day mortality.
Results: A total of 24,928 patients (7,396 statin users and 17,532 non–statin users) were included. After propensity score matching, 5,354 statin users and 7,758 non–statin users were finally included. The 90-day mortality rate was significantly higher in non–statin users (918 of 7,758; 11.8%) than in statin users (455 of 5,354; 8.5%; P < 0.001). In Cox regression analysis, the 90-day mortality rate was lower among statin users than among non–statin users (hazard ratio: 0.70, 95% CI: 0.63 to 0.79; P < 0.001). Rosuvastatin use was associated with 42% lower 90-day mortality (hazard ratio: 0.58, 95% CI: 0.47 to 0.72; P < 0.001).There were no specific significant differences in the association between daily statin dose and 90-day mortality. In competing risk analysis, the risk of noncardiovascular 90-day mortality in statin users was 32% lower than that in non–statin users (hazard ratio: 0.68, 95% CI: 0.60 to 0.78; P < 0.001). Meanwhile, cardiovascular 90-day mortality was not significantly associated with statin use.
Conclusions: Preadmission statin use was associated with a lower 90-day mortality. This association was more evident in the rosuvastatin group and with noncardiovascular 90-day mortality; no differences were seen according to daily dosage intensity.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：余晓旭 编辑：何幼芹 审校：王贵龙