Statin therapy is associated with reduced incidence of hypoxic hepatitis in critically ill patients.

Abstract

BACKGROUND & AIMS:

Hypoxic hepatitis (HH) is a frequent and life-threatening complication associated with states of oxygen depletion in critically ill patients. Ischemia and reperfusion contribute to liver injury in HH. Experimental data suggest beneficial effects of statins in hepatic ischemia/reperfusion injury. This study was conducted to investigate whether statin treatment prior to intensive care unit (ICU) admission affects incidence rates and severity of HH.

METHODS:

Eight hundred fifty-one patients admitted consecutively to three medical ICUs between December 2008 and December 2009 were prospectively screened for new occurrence of HH within 48 h following ICU admission. Statin treatment prior to ICU admission was assessed. 28-day-, 90-day-, and 1-year-survival as well as new-onset of complications in HH patients were prospectively documented.

RESULTS:

Eighty-seven patients (10%) developed HH. Statin treatment prior to ICU admission was significantly associated with decreased incidence of HH within 48 h after ICU admission in the multivariate analysis (adjusted OR=0.42 (95% CI 0.19-0.95); p<0.05). Cardiogenic shock (p<0.001), septic shock (p<0.001) and active alcohol consumption (p<0.01) were identified as independent risk factors for development of HH. 28-day-, 90-day-, and 1-year-mortality rates in HH were 58%, 67%, and 74%, respectively. Statins were associated with improved 28-day-survival in the total study cohort (p<0.05), but did not affect 90-day- and 1-year-mortality, respectively.

CONCLUSIONS:

Cardiogenic shock, septic shock, and active alcohol consumption were independent factors predisposing patients to new onset of HH. Statin treatment prior to ICU admission was the only protective factor regarding the new occurrence of HH in critically ill patients.

• Authors: Andreas Drolz, Thomas Horvatits, Barbara Michl, Kevin Roedl, Peter Schellongowski, Ulrike Holzinger, Christian Zauner, Gottfried Heinz, Christian Madl, Michael Trauner, Valentin Fuhrmann
• Journal: Journal of hepatology (J Hepatol) Vol. 60 Issue 6 Pg. 1187-93 (Jun 2014) ISSN: 1600-0641 [Electronic] Netherlands
• PMID: 24509409 (Publication Type: Journal Article)
• Copyright: Copyright © 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Chemical References

• Hydroxymethylglutaryl-CoA Reductase Inhibitors

Topics

• Aged
• Critical Illness (mortality)
• Female
• Hepatitis (mortality, prevention & control)
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (therapeutic use)
• Hypoxia (mortality, prevention & control)
• Incidence
• Intensive Care Units (statistics & numerical data)
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Prospective Studies
• Reperfusion Injury (mortality, prevention & control)
• Risk Factors
• Severity of Illness Index