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Statin Use and Hospitalization for Sepsis in Patients With Chronic Kidney Disease
Rajesh Gupta, MD;
Laura C. Plantinga, ScM;
Nancy E. Fink, MPH;
Michal L. Melamed, MD, MHS;
Josef Coresh, MD, PhD;
Caroline S. Fox, MD, MPH;
Nathan W. Levin, MD;
Neil R. Powe, MD, MPH, MBA
JAMA. 2007;297:1455-1464.
Context Patients with chronic kidney disease are at high risk for sepsis and sepsis-related mortality.
Objective To assess whether statin use is associated with a reduction in hospitalizations for sepsis in dialysis patients.
Design, Setting, and Patients National prospective cohort study that enrolled 1041 incident dialysis patients at 81 US not-for-profit outpatient dialysis clinics from October 1995 to June 1998, with follow-up to January 2005. Statin use was determined by medical record review. Rates of hospitalization for sepsis between statin users and control patients were compared using multivariate regression models, with adjustment for potential confounders in the overall cohort and in a subcohort in which control patients were matched to statin users according to their likelihood (propensity) to have been prescribed a statin.
Main Outcome Measure Hospitalizations for sepsis were determined through hospital records from the United States Renal Data System (mean follow-up, 3.4 years).
Results There were 303 hospitalizations for sepsis. Rates of sepsis-related hospitalizations were significantly lower in patients receiving statins (crude incidence rate, 41/1000 patient-years) than in those not receiving statins (crude incidence rate, 110/1000 patient-years) (P<.001). With adjustment for demographics and dialysis modality, statin users were substantially less likely to be subsequently hospitalized for sepsis (incidence rate ratio, 0.41; 95% confidence interval [CI], 0.25-0.68). Further adjustment for comorbidities and laboratory values continued to show this protective association (incidence rate ratio, 0.38; 95% CI, 0.21-0.67). In the propensity-matched subcohort, statin use was even more protective (incidence rate ratio, 0.24; 95% CI, 0.11-0.49).
Conclusions Use of statins was strongly and independently associated with a reduction in the risk of hospitalization for sepsis in patients who had chronic kidney disease and were receiving dialysis. Randomized trials of statins in patients with chronic kidney disease should examine the prevention of sepsis as a potentially important benefit.
Author Affiliations: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md (Drs Gupta, Coresh, and Powe and Mss Plantinga and Fink); Department of Epidemiology (Ms Fink and Drs Coresh and Powe), Department of Biostatistics (Dr Coresh), and Department of Health Policy and Management (Dr Powe), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md; Departments of Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (Dr Melamed); National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Mass (Dr Fox); and Renal Research Institute, New York, NY (Dr Levin). Dr Gupta is now with the Division of Cardiology, Northwestern University, Chicago, Ill.
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Statin Use and Sepsis in Patients With Chronic Kidney Disease—Reply
Rajesh Gupta, Laura C. Plantinga, Josef Coresh, and Neil R. Powe
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Correction: Inaccurate Classification and Information Reported in a Study of Statin Use and Sepsis in Patients With Chronic Kidney Disease
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JAMA. 2008;299(7):765.
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