STATIN THERAPY PRIOR TO SEPTIC SHOCK IS ASSOCIATED WITH A REDUCED RISK OF ARDS

Abstract

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: A potential benefit of statins in reducing the risk of acute respiratory distress syndrome (ARDS) was shown in a septic shock animal model, however, this effect hasn't been replicated in patients after they have developed ARDS. We aimed to evaluate the effect of statin therapy prior to admission in patients with septic shock on the risk of developing ARDS METHODS: A retrospective cohort of patients with septic shock in a community hospital ICU from December 2013 to December 2014 was complied. Patients who met criteria for septic shock were included. ARDS was defined based on the Berlin Criteria. Statin use prior to admission was determined from the home medication list. Demographic, clinical and laboratory data were collected. ARDS, ICU and hospital length of stay, and ventilator days were defined as outcomes. A multivariate regression analysis was employed with statin prior to admission as the independent variable, and ARDS as the dependent variable RESULTS: Of the 128 included patients, 61% were female, 71% were white, and the mean age was 67 years.The most common causes of septic shock were: intra-abdominal infection 34%, pneumonia 31%, and urinary tract infection 20%. In our sample, 56% of patients required mechanical ventilation, and the overall mortality was 50%. A total of 22% met criteria for ARDS with a mean PaFiO2 ratio of 128 (SD 67). Prior to admission 33% of patients were taking a statin. Patients taking statins were more likely to be older (73.7 +/- 10 vs 64.4 +/- 18; p=0.002), have diabetes mellitus (59% vs 40%; p=0.033), take aspirin (50% vs 19%; p<0.001), take beta blockers (47.6% vs 26%; p=0.013), have higher serum albumin levels (2.6 g/dL +/- 0.76 vs 2.1 +/- 0.74), and less likely to have cirrhosis (0% vs 12%; p=0.021). Patients taking a statin were less likely to develop ARDS (7% vs 29%; p=0.005). In the subset of patients on statins prior to admission, there was no significant difference in incidence of ARDS based on continuation of statin upon admission to the ICU (4.2% vs 11%; p=0.387). When controlling for age, gender, race, diabetes, aspirin, beta blockers, cirrhosis, pneumonia, albumin level, and lactate level, statin use prior to admission was associated with a significantly decreased risk of ARDS (OR 0.18; p=0.03). Statin use prior to admission was not associated with a significant reduction in length of stay (12.8 +/- 13.2 vs 15.4 +/- 16.1; p=0.365), ICU length of stay (4.7 +/- 4.8 vs 6.0 +/- 6.3; p=0.244), or ventilator days (3.1 +/- 5.6 vs 3.8 +/- 5.7; p=0.528). CONCLUSION(S): Statin therapy prior to septic shock was associated with a significantly decreased risk of developing ARDS in this retrospective cohort of community hospital patients CLINICAL IMPLICATIONS: Statins appear to reduce the risk of ARDS when patients have been taking them prior to developing septic shock. Further research into the mechanism by which statins modulate the pathogenesis of ARDS is warranted DISCLOSURES: No relevant relationships by Andres Chacon, source=Web Response No relevant relationships by Elie Donath, source=Admin input No relevant relationships by Brian Garnet, source=Web Response No relevant relationships by Mehdi Mirsaeidi, source=Web Response No relevant relationships by Juan Teran Plasencia, source=Web Response no disclosure on file for Adam Wellikoff;Copyright © 2019 American College of Chest Physicians