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To the Editor: Dr Gupta and colleagues¹ found that the use of statins was independently associated with reduction in the risk of hospitalization for sepsis in patients with chronic kidney disease receiving dialysis. Several potential underlying mechanisms were invoked to explain an effect of statins, and we would like to add another possibility.

Statins increase the level of apolipoprotein (apo) A-I, the major protein component of high-density lipoprotein cholesterol, as well as the ratio of apo A-I to apo B.² Apolipoprotein A-I has the ability to bind and clear lipopolysaccharide (endotoxin) and thereby protect against further lipopolysaccharide-induced cytokine activation.³ Furthermore, apo A-I can specifically block the interaction between activated T lymphocytes and monocytes, inhibiting production of tumor necrosis factor and interleukin 1 in monocytes in the serum of healthy volunteers.⁴ As a clinical equivalent of this laboratory finding, we showed that a low serum level of apo A-I in critically . . . [Full Text of this Article]

Catherine Chenaud, MD; Paolo Merlani, MD
paolo.merlani@hcuge.ch
Intensive Care Service
Department of Anesthesiology, Pharmacology and Intensive Care
University of Geneva Hospitals
Geneva, Switzerland

RELATED LETTER

Statin Use and Sepsis in Patients With Chronic Kidney Disease—Reply
Rajesh Gupta, Laura C. Plantinga, Josef Coresh, and Neil R. Powe
JAMA. 2007;298(3):284-285.
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Statin Use and Hospitalization for Sepsis in Patients With Chronic Kidney Disease
Rajesh Gupta, Laura C. Plantinga, Nancy E. Fink, Michal L. Melamed, Josef Coresh, Caroline S. Fox, Nathan W. Levin, and Neil R. Powe
JAMA. 2007;297(13):1455-1464.
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