Abstract
Objective. To investigate whether prior treatment of atorvastatin reduces the frequency of hospital acquired pneumonia (HAP). Methods. Totally, 492 patients with acute ischemic stroke and Glasgow Coma Scale ≤ 8 were enrolled in this study. Subjects were assigned to prior atorvastatin treatment group (n = 268, PG) and no prior treatment group (n = 224, NG). All the patients were given 20 mg atorvastatin every night during their hospital stay. HAP frequency and 28-day mortality were measured. Levels of inflammatory biomarkers [white blood cell (WBC), procalcitonin (PCT), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6)] were tested. Results. There was no significant difference in the incidence of HAP between PG and NG (25.74% versus. 24.55%, p > 0.05) and 28-day mortality (50.72% versus 58.18%, p > 0.05). However, prior statin treatment did modify the mortality of ventilator associated pneumonia (VAP) (36.54% versus 58.14%, p = 0.041) and proved to be a protective factor (HR, 0.564; 95% CI, 0.310~0.825, p = 0.038). Concentrations of TNF-α and IL-6 in PG VAP cases were lower than those in NG VAP cases (p < 0.01). Conclusions. Prior atorvastatin treatment in patients with ischemic stroke was associated with a lower concentration of IL-6 and TNF-α and improved the outcome of VAP. This clinical study has been registered with ChiCTR-ROC-17010633 in Chinese Clinical Trial Registry.
Highlights
Hospital acquired pneumonia (HAP) which constitutes a frequent infection in intensive care unit (ICU) patients consumes vast healthcare resources and increases proportionally to the duration of ICU stay
Patients were eligible for enrolment if they were diagnosed with acute ischemic stroke by magnetic resonance imaging (MRI); were aged between 18 and 80 years; had Glasgow Coma Scale (GCS) ≤ 8
In this prospective observational study, we found that therapy with statins for at least one month before the onset of acute ischemic stroke was probably associated with a decreased mortality of Ventilator associated pneumonia (VAP) during 28-day ICU treatment
Summary
Hospital acquired pneumonia (HAP) which constitutes a frequent infection in intensive care unit (ICU) patients consumes vast healthcare resources and increases proportionally to the duration of ICU stay. Ventilator associated pneumonia (VAP) is defined as HAP in patients receiving mechanical ventilation [1, 2]. The incidence of HAP depends on the population studied. In patients with ischemic stroke who are characterized by advanced age, depressed level of consciousness, immune suppression, and long-term bed rest, the incidence of HAP can increase to approximately 40%. It is recognized that one-third to half of all HAP-related deaths are directly attributable to pneumonia [3]. Despite improvements in bundle care prevention, mortality continues to remain high. New effective adjunctive therapies are still needed for HAP prevention and treatment
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