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Potential role of statins as immunomodulators in pneumococcal pneumonia.

机译：他汀类药物在肺炎球菌性肺炎中作为免疫调节剂的潜在作用。

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摘要

Background: Mortality in pneumococcal pneumonia remains as high as 20%, and most deaths occur within the first two weeks of hospitalization despite eradication of the causative organisms by antimicrobials in the first 24 hours. An inflammatory response rather than active infection could be responsible for this early mortality. Statins have been shown to have potent immunomodulatory activity in vitro. We investigated whether there was decreased severity or improved outcome in patients who were receiving statins at the time they were admitted for pneumococcal pneumonia.;Methods: Patients seen at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas from January, 2000 to June, 2010 with a diagnosis of pneumococcal pneumonia were included in this retrospective cohort study. Electronic medical records were reviewed to record demographic characteristics, comorbidities, laboratory values and statin use at the time of admission. Severity of pneumonia was determined using the Pneumonia Outcomes Research Team (PORT) classification. Uni- and multivariate Cox regression was used to evaluate survival. We adjusted for all variables in the multivariate model if they were significant in the univariate model at p<0.05.;Results: Of 347 patients admitted for pneumococcal pneumonia, 90 (25.9%) were taking statins at the time of presentation. Patients in the statin group were older (age: 68.0+/-9.7 vs. 62.5+/-12.3 years, p<0.001) and had higher prevalence of diabetes, coronary artery disease and kidney disease (p<0.05 for each comparison). Liver disease and alcohol consumption were less prevalent among statin users (p<0.05). The PORT scores were normally distributed in both groups with statin users having higher mean scores at admission as compared to patients not on statins (108+/-32 vs. 96+/-32, p = 0.002). The Cox proportional hazard analyses, adjusted for age, comorbidities, length of stay and PORT scores, showed a significantly reduced risk of mortality among statin users at 14 days (HR: 0.39; 0.15-0.98, p=0.045), 20 days (0.35; 0.14- 0.88, p=0.03) and 30 days(0.41; 0.17-0.95, p=0.01) after presentation.;Conclusion: Statin use is associated with improved clinical outcomes in patients with pneumococcal pneumonia.
机译：背景：肺炎球菌性肺炎的死亡率仍高达20％，尽管在最初的24小时内已通过抗菌剂消除了致病菌，但多数死亡发生在住院的前两周内。炎性反应而非主动感染可能是造成这种早期死亡的原因。他汀类药物已显示出在体外具有有效的免疫调节活性。我们调查了接受他汀类药物治疗的肺炎球菌性肺炎患者时他汀类药物的严重程度是否降低或转归是否有所改善。方法：2000年1月至2000年1月在得克萨斯州休斯敦的Michael E. DeBakey退伍军人事务医疗中心就诊的患者这项回顾性队列研究纳入了2010年6月诊断为肺炎球菌性肺炎的患者。审查电子病历，以记录入院时的人口统计学特征，合并症，实验室值和他汀类药物的使用。肺炎的严重程度是通过肺炎结果研究小组（PORT）分类确定的。单因素和多元Cox回归用于评估生存率。我们对多变量模型中的所有变量进行了校正，如果它们在单变量模型中具有显着性（p <0.05）。他汀类药物组的患者年龄较大（年龄：68.0 +/- 9.7对62.5 +/- 12.3岁，p <0.001），并且糖尿病，冠状动脉疾病和肾脏疾病的患病率更高（每次比较，p <0.05）。他汀类药物使用者中肝病和饮酒的患病率较低（p <0.05）。两组的PORT分数均呈正态分布，与未使用他汀类药物的患者相比，他汀类药物使用者入院时的平均得分更高（108 +/- 32比96 +/- 32，p = 0.002）。经过年龄，合并症，住院时间和PORT评分调整的Cox比例风险分析显示，他汀类药物使用者在14天（HR：0.39; 0.15-0.98，p = 0.045），20天（0.35）时的死亡风险显着降低。 ； 0.14-0.88，p = 0.03）和出现后30天（0.41； 0.17-0.95，p = 0.01）。结论：使用他汀类药物可改善肺炎球菌性肺炎患者的临床结局。

著录项

  • 作者

    Doshi, Simit Mahesh.;

  • 作者单位

    The University of Texas School of Public Health.;

  • 授予单位 The University of Texas School of Public Health.;
  • 学科 Health Sciences Medicine and Surgery.
  • 学位 M.P.H.
  • 年度 2011
  • 页码 30 p.
  • 总页数 30
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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