Statins failed to improve day-28 survival in VAP
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Therapy with a statin did not improve survival among patients with suspected ventilator-associated pneumonia, according to researchers for the STATIN-VAP Study Group.
“Many clinical studies have been performed to evaluate whether the pleiotropic effects [of statins] are beneficial in infections, although most used an observational design,” the researchers wrote in JAMA. “Ventilator-associated pneumonia … remains associated with increased mortality rates and high health care costs. Thus, new adjunctive treatments are needed.”
The researchers conducted a randomized, placebo-controlled, double blind trial from 2010 to March 2013. The study included 300 patients requiring invasive mechanical ventilation for more than 2 days, who had suspected ventilator-associated pneumonia (VAP). The patients were randomly assigned to 60 mg simvastatin or placebo.
There was no decrease in day-28 mortality in those who received simvastatin: 21.2% vs. 15.2% in the placebo group. In the simvastatin group, 106 patients were diagnosed with probable VAP and 105 were diagnosed in the placebo group. When the analysis was restricted just to these patients, the results were similar: day-28 mortality was 22.6% with simvastatin vs. 14.3% for placebo. Among the subgroup of patients naive to statins at admission, the day-28 mortality was 21.5% with simvastatin and 13.8% with placebo.
“It should be emphasized that although our study was not designed to test whether a placebo was superior to simvastatin, there was a nearly 6% absolute increase in day-28 mortality in the simvastatin group overall and a nearly 8% absolute increase in the statin-naive group,” the researchers wrote.
There were no significant differences between the groups for day-14, ICU or hospital mortality rates, duration of mechanical ventilation, number of ventilator-free days by day 28 or changes in Sequential Organ Failure Assessment score. Simvastatin was well tolerated.
“Our results do not support the use of adjunctive statin therapy in ICU patients with VAP, and this conclusion probably deserves to be extended to ICU patients with any type of nosocomial infection,” the researchers wrote.
Disclosure: Some researchers have received compensation from Air Liquide Santé, Faron, Fresenius Kabi, Gilead, MSD, Merck France and Pfizer.