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Meta-Analysis
. 2014 Apr 11;18(2):R71.
doi: 10.1186/cc13828.

Effect of statin therapy on mortality from infection and sepsis: a meta-analysis of randomized and observational studies

You-Dong Wan, Tong-Wen Sun, Quan-Cheng Kan, Fang-Xia Guan, Shu-Guang Zhang
Meta-Analysis

Effect of statin therapy on mortality from infection and sepsis: a meta-analysis of randomized and observational studies

You-Dong Wan et al. Crit Care. .

Abstract

Introduction: Observational data have suggested that statin therapy may reduce mortality in patients with infection and sepsis; however, results from randomized studies are contradictory and do not support the use of statins in this context. Here, we performed a meta-analysis to investigate the effects of statin therapy on mortality from infection and sepsis.

Methods: We searched electronic databases (PubMed and Embase) for articles published before November 2013. Randomized or observational studies reporting the effects of statin therapy on mortality in patients with infection or sepsis were eligible. Randomized and observational studies were separately pooled with relative risks (RRs) and random-effects models.

Results: We examined 5 randomized controlled trials with 867 patients and 27 observational studies with 337,648 patients. Among the randomized controlled trials, statins did not significantly decrease in-hospital mortality (RR, 0.98; 95% confidence interval (CI), 0.73 to 1.33) or 28-day mortality (RR, 0.93; 95% CI, 0.46 to 1.89). However, observational studies indicated that statins were associated with a significant decrease in mortality with adjusted data (RR, 0.65; 95% CI, 0.57 to 0.75) or unadjusted data (RR, 0.74; 95% CI, 0.59 to 0.94).

Conclusions: Limited evidence suggests that statins may not be associated with a significant reduction in mortality from infection and sepsis. Although meta-analysis from observational studies showed that the use of statins was associated with a survival advantage, these outcomes were limited by high heterogeneity and possible bias in the data. Therefore, we should be cautious about the use of statins in infection and sepsis.

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Figures

Figure 1
Figure 1
Flow diagram for selection of articles.
Figure 2
Figure 2
Forest plot of randomized controlled trials. A. This is a forest plot for the relative risk of in-hospital mortality and 28-day mortality from randomized controlled trials. B. This is a forest plot for the rate need for MV or ICU admission and the rate of new development of severe sepsis from randomized controlled trials.
Figure 3
Figure 3
Forest plot of observational cohort studies A. A forest plot for the relative risk of mortality from observational cohort studies with adjusted data. B. A forest plot for the relative risk of mortality from observational cohort studies with unadjusted data.
Figure 4
Figure 4
Funnel plot for the risk of mortality from observational cohort studies with adjusted data. RR, relative risk; s.e., standard error.
See this image and copyright information in PMC

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