Do statins have a role in preventing or treating sepsis?

Abstract

Statins have a variety of properties that are independent of their lipid lowering ability. These anti-inflammatory, antioxidant, immunomodulatory, and antiapoptotic features have been collectively referred to as pleiotropic effects. Severe sepsis is an intense infection-induced inflammatory syndrome that ultimately results in organ dysfunction. Because so many cascades are triggered during sepsis, merely blocking a single component may be insufficient to arrest the inflammatory process. A growing body of evidence suggests that statins may indeed have a protective effect against severe sepsis and reduce the rate of infection-related mortality. This novel primary prevention concept may have far-reaching implications for the future management of serious infections. Moreover, it was recently shown that statins potentially improve outcome after the onset of sepsis. The stage is now set for randomized clinical trials that will determine the precise role, if any, that statins may have in preventing and treating sepsis.

Figure 1

Key events leading from infection to multiorgan failure. For the sake of clarity, not all interactions and pathways are shown. 'S' denotes possible sites where statins might be exerting their beneficial effect. Shown in italics are some of the main clinical manifestations pertinent to specific elements of the inflammatory cascade. CRP, C-reactive protein; DIC, disseminated intravascular coagulation; HO, heme oxygenase; NO, nitric oxide; SIRS, systemic inflammatory response syndrome.