Statins may reduce sepsis death by 39%

A new study by Chinese scientists has sparked hope for improved management of sepsis, a potentially life-threatening medical emergency. The research suggests that statins, a commonly-used cholesterol-busting medication, could cut the mortality risk for some patients. The findings are striking, but require validation in large randomised trials.

‘Our large, matched cohort study found that treatment with statins was associated with a 39% lower death rate for critically ill patients with sepsis, when measured over 28 days after hospital admission,’ said Dr Caifeng Li, the study’s corresponding author and an associate professor at Tianjin Medical University General Hospital in China.

Statins are best known as a protective treatment against cardiovascular disease, but they have been shown to bring a plethora of further benefits. ‘Statins have anti-inflammatory, immunomodulatory, antioxidative, and antithrombotic properties. They may help mitigate excessive inflammatory response, restore endothelial function, and show potential antimicrobial activities,’ said Li.

The authors used data from the anonymised e-health records of 265,000 patients with a diagnosis of sepsis hospitalised for longer than 24 hours. The authors compared outcomes between patients who received or didn’t receive any statins during their stay besides standard of care, regardless of the type of statin. Unlike in randomised clinical trials – the gold standard among clinical studies – the allocation of treatments is not determined by random in observational studies like the present cohort study.

However, Li and colleagues used a technique called ‘propensity score matching’ to minimise the risk of bias: they built a statistical model to determine a likelihood score that a given patient would receive statins, based on their medical records, and then found a matching patient with a similar score, but who didn’t receive statins. In the final sample, 6,070 critical patients received statins while another 6,070 did not.

The primary analysis focused on 28-day all-cause mortality, while supplementary analyses examined outcomes such as the duration of the hospital stay, of mechanical ventilation, and of continuous renal replacement therapy.

The results showed that the 28-day all-cause mortality rate was 14.3% in the statin group and 23.4% in the no statin group, indicating a relative reduction by 39% [9.1 percentage points]. However, the duration of mechanical ventilation (MV) or continuous renal replacement therapy (CRRT) increased by an average of 3 hours and 26 hours, respectively, in the group receiving statins. This prolonged duration of MV and CRRT in the statin group may be attributed to a tradeoff between 28-day all-cause mortality and the duration of MV or CRRT.

‘These results strongly suggest that statins may provide a protective effect and improve clinical outcomes for patients with sepsis,’ concluded Li. Supplementary analyses confirmed these results separately for patients with a normal, overweight, or obese body mass index, but not for underweight patients.

‘Previous randomised controlled trials may not have found a benefit of statins in patients with sepsis due to underreporting of sepsis diagnoses, small sample sizes, and failure to account for the complex interactions between statin use and patient characteristics,’ suggested Li.

‘An ideal trial to confirm or reject our results should include a large sample size of sepsis patients, with detailed information on statin types, doses, and treatment duration. It should also carefully consider the timing of statin initiation and control for potential confounders,’ said Li.