The influence of statin exposure on inflammatory markers in patients with early bacterial infection: pilot prospective cohort study
The influence of statin exposure on inflammatory markers in patients with early bacterial infection: pilot prospective cohort study
Background
In the context of infection, progressive illness resulting in acute organ dysfunction is thought to be secondary to inflammatory response. Our aims were to determine risk factors for progressive illness following infection in a low-risk hospitalised cohort, including the impact of prior stain therapy.
Methods
We performed a prospective observational cohort study on two adult acute medical wards of a single tertiary academic hospital. We screened drug prescription charts of all adult acute medical admissions for inclusion criteria of inpatient administration of antibiotics for more than 24 hours for a microbiologically confirmed or clinically suspected infection. Patients were followed until admission to a high dependency unit (HDU) or intensive care unit (ICU), discharge from hospital, or to a maximum of 10 days. Outcomes were evolution of systemic inflammatory response syndrome (SIRS) criteria, white cell count and C-reactive protein measurements, and adverse clinical outcomes. We constructed multivariable models accounting for repeated within-patient measurements to determine associations between a priori selected predictors (days since admission, age, gender, Charlson score, prior statin exposure) and selected outcomes.
Results
We enrolled 209 patients; 27.8% were statin users and the commonest infection was pneumonia (51.0%). Most (88.0%) had at least 1 SIRS criterion on admission, and 76 (37.3%) manifested additional SIRS criteria over time. Risks of admission to HDU/ICU (3.3%) and of 30-day mortality (5.7%) were low. The proportion of patients with at least 1 SIRS criterion, mean CRP, and mean WBC all decreased over time. Multivariable regression models identified days since hospital admission as the only variable associated with daily presence of SIRS criteria, WCC, or CRP (adjusted OR <1 and p < 0.0001 in all analyses). Statin exposure was not a significant predictor.
Conclusions
This cohort of ward patients treated for infection had a low risk of clinical deterioration, inflammatory markers improved over time, and statin exposure was not associated with any outcome. Future larger studies may identify risk factors for progression of illness in this population and plausible surrogate endpoints for evaluation in clinical trials.
Shankar-Hari, M.
6168fb5a-39fd-4713-a885-e7479d6b6775
Donnelly, A.
ce388b84-9943-460f-806b-2ecf1e517877
Pinto, R.
1c0112e0-96ec-4484-8847-cee8f3fdad41
Salih, Z.
611da28a-a821-4557-b7c9-bc022f8b059d
McKenzie, C.
ec344dee-5777-49c5-970e-6326e82c9f8c
Terblanche, M.
2312ce3f-dd59-4938-a495-7018e1f73407
Adhikari, N.K.J.
d6cfd3aa-56ae-42fb-81ac-d6d8b3b389ed
November 2014
Shankar-Hari, M.
6168fb5a-39fd-4713-a885-e7479d6b6775
Donnelly, A.
ce388b84-9943-460f-806b-2ecf1e517877
Pinto, R.
1c0112e0-96ec-4484-8847-cee8f3fdad41
Salih, Z.
611da28a-a821-4557-b7c9-bc022f8b059d
McKenzie, C.
ec344dee-5777-49c5-970e-6326e82c9f8c
Terblanche, M.
2312ce3f-dd59-4938-a495-7018e1f73407
Adhikari, N.K.J.
d6cfd3aa-56ae-42fb-81ac-d6d8b3b389ed
Shankar-Hari, M., Donnelly, A., Pinto, R., Salih, Z., McKenzie, C., Terblanche, M. and Adhikari, N.K.J.
(2014)
The influence of statin exposure on inflammatory markers in patients with early bacterial infection: pilot prospective cohort study.
BMC Anesthesiology, 14, [106].
(doi:10.1186/1471-2253-14-106).
Abstract
Background
In the context of infection, progressive illness resulting in acute organ dysfunction is thought to be secondary to inflammatory response. Our aims were to determine risk factors for progressive illness following infection in a low-risk hospitalised cohort, including the impact of prior stain therapy.
Methods
We performed a prospective observational cohort study on two adult acute medical wards of a single tertiary academic hospital. We screened drug prescription charts of all adult acute medical admissions for inclusion criteria of inpatient administration of antibiotics for more than 24 hours for a microbiologically confirmed or clinically suspected infection. Patients were followed until admission to a high dependency unit (HDU) or intensive care unit (ICU), discharge from hospital, or to a maximum of 10 days. Outcomes were evolution of systemic inflammatory response syndrome (SIRS) criteria, white cell count and C-reactive protein measurements, and adverse clinical outcomes. We constructed multivariable models accounting for repeated within-patient measurements to determine associations between a priori selected predictors (days since admission, age, gender, Charlson score, prior statin exposure) and selected outcomes.
Results
We enrolled 209 patients; 27.8% were statin users and the commonest infection was pneumonia (51.0%). Most (88.0%) had at least 1 SIRS criterion on admission, and 76 (37.3%) manifested additional SIRS criteria over time. Risks of admission to HDU/ICU (3.3%) and of 30-day mortality (5.7%) were low. The proportion of patients with at least 1 SIRS criterion, mean CRP, and mean WBC all decreased over time. Multivariable regression models identified days since hospital admission as the only variable associated with daily presence of SIRS criteria, WCC, or CRP (adjusted OR <1 and p < 0.0001 in all analyses). Statin exposure was not a significant predictor.
Conclusions
This cohort of ward patients treated for infection had a low risk of clinical deterioration, inflammatory markers improved over time, and statin exposure was not associated with any outcome. Future larger studies may identify risk factors for progression of illness in this population and plausible surrogate endpoints for evaluation in clinical trials.
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More information
Accepted/In Press date: 25 September 2014
e-pub ahead of print date: 19 November 2014
Published date: November 2014
Identifiers
Local EPrints ID: 479251
URI: http://eprints.soton.ac.uk/id/eprint/479251
ISSN: 1471-2253
PURE UUID: 14fffc58-bfc6-4674-a957-586736309ce0
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Date deposited: 20 Jul 2023 16:48
Last modified: 17 Mar 2024 04:23
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Contributors
Author:
M. Shankar-Hari
Author:
A. Donnelly
Author:
R. Pinto
Author:
Z. Salih
Author:
C. McKenzie
Author:
M. Terblanche
Author:
N.K.J. Adhikari
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